Prior Authorization Specialist Resume Example

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(555) 432-1000,
, , 100 Montgomery St. 10th Floor

Reliable Administrative Assistant with over 6+ years of experience working in fast-paced, clinical environments. Amiable professional with skills in prior authorization, billing, and data management for patients, finding solutions to issues and tackling work tasks in a busy office. Diligent tracker with connecting patients and healthcare providers to vital resources. Dedicated to executing on prescribed medical funding guidelines and policies. I maintain compassionate and sympathetic relations with patients and consumers. Adept at balancing business interests with human-centric service models. Detailed Administrative Assistant committed to never letting vital requests or documents go unprocessed. I incorporate empathetic communications with professional best practices to satisfy plan members and business goals alike. Flexible and disciplined in fast-paced office settings. Expertise completing various clerical tasks and offering staff support. Responsible, punctual and productive professional when working with little to no supervision. Strong client relations skills and ability to resolve issues with tact and diplomacy to drive client retention and loyalty. Knowledgeable in industry terminology, products and services to effectively address and respond to public and personnel inquiries.

  • Proficiency in Medconnect, IDX/ GE Centricity Business/ EPIC
  • First Aid/CPR
  • Effective communication skills
  • Benefit Coverage
  • Prescription Coordination
  • Patient Scheduling
  • Understanding of insurance details
  • Medical terminology
  • Claim research
  • Authorizations
  • Payment collection
  • Responsible
  • Relationship-Building
  • Telephone etiquette
  • Precertification requirements
  • MS Office/ Word/ Excel/ Powerpoint
  • File and data retrieval systems
  • Project management
Education and Training
Trinity Washington University Washington, DC Expected in 05/2016 Associate of Science : Business Administration And Management - GPA :
Anacostia High School Washington, DC Expected in 06/2013 High School Diploma : - GPA :
  • Certified CPR/ADULT/AED, Redcross - 2018-2022
Francisan Health - Prior Authorization Specialist
Lafayette, IN, 09/2020 - 01/2021
  • Managed IDX/ GE Centricity Business databases converting complex data into easy-to-interpret data
  • Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
  • Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
  • Reviewed insurance coverage for patients to determine which party was liable for payment.
  • Tracked referral submission during facilitation of prior authorization issuance.
  • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
  • Reached out to insurance carriers to obtain prior authorization for testing and procedures.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Authorized surgical requests in accordance with applicable plan guidelines.
  • Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
Qualtek - Administrative Assistant
Dallas, TX, 04/2016 - 04/2020
  • Organized and maintained filing and document management systems by coordinating, archiving and purging files.
  • Developed administrative processes to achieve organizational objectives and improve office efficiency.
  • Handled management of communication to executives by taking and making telephone calls, reviewing and prioritizing mail and composing and typing correspondence.
  • Entered invoice data into company database and updated details, including customer contacts and delivery dates to keep information current.
  • Coordinated project materials by managing physical and digital files, monitoring spreadsheets and updating reports.
  • Directed customer communication to appropriate department personnel.
  • Prepared packages for shipment by generating packing slips and setting up courier deliveries.
  • Arranged travel and hotel accommodations for international and domestic business meetings and trips.
  • Collected, calculated and reported on expenditure and statistical data to inform senior management.
United Medical Center - ER Registration Representative
City, STATE, 06/2013 - 04/2015
  • Documented patient medical information, case histories and insurance details to facilitate smooth appointments and payment processing.
  • Enhanced office efficiency by handling 75-100+ callers per day.
  • Completed skilled administrative work to support all office staff and operational requirements.
  • Managed master calendar and scheduled appointments for 6 providers based on optimal patient loads and clinician availability.
  • Maintained current and accurate medical records for over 150-200+ patients.
  • Organized paperwork such as charts and reports for office and patient needs.
  • Completed and filed financial documentation for accounting purposes.
  • Responded to correspondence from insurance companies to verify patient's coverage.
  • Used computer programs and registration systems to schedule patients for routine and complex procedures.

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Resume Strength

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Resume Overview

School Attended
  • Trinity Washington University
  • Anacostia High School
Job Titles Held:
  • Prior Authorization Specialist
  • Administrative Assistant
  • ER Registration Representative
  • Associate of Science
  • High School Diploma

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