prior authorization specialist resume example with 7 years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105(555) 432-1000, resumesample@example.com
Professional Summary
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for detox and residential substance abuse treatment. Detail-oriented performer with 3 years of managing documentation. Incorporates empathetic communications with professional best practices to satisfy plan members and business goals alike. Considered team player with exemplary multitasking skills.
Skills
Authorizations
Insurance Information Oversight
Status Updates
Health Insurance Plan Knowledge
Healthcare Terminology
Medical Information Collection
Confidential Records Management
Effective communication skills
Behavioral Health
Work History
10/2019 to CurrentPrior Authorization SpecialistNavitus | Phoenix, AZ,
Reached out to insurance carriers to obtain prior authorization for detox and residential treatment.
Input all patient data regarding prior authorizations into computer system accurately using Kipu.
Assessed information gleaned from interviews, educational, and medical records, consultation with other professionals and diagnostic evaluations to identify clients' abilities, needs and eligibility for services.
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.
Created and maintained spreadsheets detailing insurance denials and approvals.
Obtained authorizations from multiple insurance carriers for various levels of care.
Verified eligibility and compliance with authorization requirements for service providers.
Fielded telephone inquiries on authorization details from plan members and medical staff.
Supervised and maintained all utilization review documentation through Kipu.
04/2016 to 10/2019Family NannyPrivate Household | City, STATE,
Built positive and nurturing environments to support child social and emotional growth.
Prepared tasty, healthy meals for children to encourage good eating habits.
Facilitated relationships with children and parents by developing caring and structured home environments.
Balanced playtime and limited screen time to support development of fine motor, gross motor and cognitive skills.
Drove children to swim classes.
Traveled with families to care for children, allowing parents to share private time while giving children fun adventures in diverse environments.
Assisted with light housekeeping duties as well as running errands.
Developed games and activities using arts and crafts to support learning and verbal skills.
Worked with parents to develop and implement discipline programs to promote positive behavior.
Coordinated field trips to local parks, museums and zoos.
Maintained updated list of emergency contact information and child's health information in case of emergencies.
09/2015 to 04/2016Behavioral Health ParaprofessionalSundance Rehabilitation | City, STATE,
Built and maintained positive staff relationships to promote teamwork and better serve clients.
Performed client intake procedures according to internal standards for new admissions.
Facilitated on-site activities, support groups and outings for clients.
Recognized individuals under influence of drugs or alcohol and typical behaviors associated with each.
Searched resident belongings prior to and during stays.
Kept facility clean, performed basic maintenance and restocked supplies to support program needs.
Taught clients how to complete basic household chores and prepare food.
Conducted client rounds to check on residents and their rooms.
Prepared and submitted daily reports to management.
Charted on each patient daily.
Treated clients and families with respect and dignity.
Took and monitored vital signs, administered medications and managed patient behavior.
Demonstrated respect, friendliness and willingness to help wherever needed.
Displayed sensitivity to cultural and linguistic needs of clients and families served.
Maintained energy and enthusiasm in fast-paced environment.
Interviewed clients, reviewed records and conducted assessments to evaluate mental or physical condition of clients or patients.
Guided clients in effective therapeutic exercises integrated from Cognitive Behavior Therapy and Dialectical Behavior Therapy (DBT).
Communicated back to nurses and therapists regarding patient performance and condition.
Maintained medicine and equipment inventory, issued supplies to staff and notified personnel to procure more stock.
Informed nurses and therapists of any requests from physicians, patients, and visitors.
Answered telephones and performed light clerical duties to maintain smooth operations while attending to various program needs.
Scheduled patient appointments.
Reported patients' progress, attitudes and accomplishments to supervisors or therapists.
Education
Expected in 06/2010 to to High School Diploma | Indian Trail High School And Academy, Kenosha, WIGPA:
Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.