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prior authorization specialist resume example with 4+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Summary

Passionate Intern offering proficiency in research, data entry and records management. Pursuing BA in Psychology degree with strong background in retrieving, analyzing and presenting data in meaningful formats. Maintains high level of confidentiality and professionalism at all times.

Education and Training
Saint Leo University Saint Leo, FL, Expected in 05/2022 Bachelor of Arts : Clinical/Counseling Psychology - GPA :
Kenwood High School Clarksville, TN Expected in 05/2013 High School Diploma : - GPA :
Tallahassee Community College Tallahassee, FL Expected in 05/2019 Associate of Arts : - GPA :
Certifications
  • CPR Certification
  • Home Health Aide (HHA)
Experience
Francisan Health - Prior Authorization Specialist
Crawfordsville, IN, 11/2020 - Current
  • Assist patients with filling prescriptions.
  • Assist with completion of prior authorization for uncovered medications.
  • Apply knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
  • Determine which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
  • Collaborate with internal departments to provide account status updates.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
DCI, Inc - Dialysis Technician/PCT
City, STATE, 06/2020 - 11/2020
  • Followed infection control measures when cleaning and attaching hemodialysis machine to access sites like fistulas, catheters, and grafts.
  • Took and documented patient temperature, blood pressure, pulse and respiration rates before and after dialysis treatment.
  • Inspected equipment and conducted safety checks on equipment and instruments to maintain high-quality control standards.
  • Observed patients for adverse reactions and monitored hemodialysis machines for malfunctions.
  • Initiated dialysis treatment according to prescribed orders.
  • Analyzed registered venous arterial pressures to meet established limits.
Davita Dialyis Kidney Care - Dialysis Technician/PCT
City, STATE, 06/2019 - 06/2020
  • Followed infection control measures when cleaning and attaching hemodialysis machine to access sites like fistulas, catheters, and grafts.
  • Took and documented patient temperature, blood pressure, pulse and respiration rates before and after dialysis treatment.
  • Inspected equipment and conducted safety checks on equipment and instruments to maintain high-quality control standards.
  • Observed patients for adverse reactions and monitored hemodialysis machines for malfunctions.
  • Initiated dialysis treatment according to prescribed orders.
  • Analyzed registered venous arterial pressures to meet established limits.
Conduent - Health Insurance Agent/ Provider
City, STATE, 11/2016 - 11/2018
  • Spoke directly with providers dealing with diagnosis/procedure codes.
  • Verified benefits for Medicare part C
  • Participated in weekly training sessions to improve product knowledge and enhance company growth.
  • Researched customer issues to understand problems and developed successful resolutions for Medicare accounts.
  • Displayed strong telephone etiquette, effectively handling difficult calls.
Willing to relocate: Anywhere
Additional Information
  • Willing to relocate: (Florida), Authorized to work in the US for any employer

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Resume Overview

School Attended

  • Saint Leo University
  • Kenwood High School
  • Tallahassee Community College

Job Titles Held:

  • Prior Authorization Specialist
  • Dialysis Technician/PCT
  • Dialysis Technician/PCT
  • Health Insurance Agent/ Provider

Degrees

  • Bachelor of Arts
  • High School Diploma
  • Associate of Arts

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