prior authorization specialist resume example with 16+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - : - -

Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

  • Knowledgeable in EPIC
  • Understanding of Medical Terms
  • Precertification Requirements
  • Issue Research
  • Telephone Etiquette
  • Recordkeeping and Data Input
  • People Skills
  • Friendly, Positive Attitude
  • Computer Skills
  • Customer Service
  • Critical Thinking
  • Microsoft Office
  • Good Work Ethic
  • Reliable & Trustworthy
04/2021 to Current
Prior Authorization Specialist Oregon Medical Group Springfield, OR,
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Collaborated with internal departments to provide account status updates.
  • Notified ordering providers of denied authorizations.
  • Coordinated resolutions for issues and appealed denied authorizations.
  • Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
  • Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
  • Maintained files for referral and insurance information, entering referrals into system.
  • Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
  • Maintained positive working relationship with fellow staff and management.
  • Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
  • Proofread documents carefully to check accuracy and completeness of all paperwork.
02/2020 to 04/2021
Toddler Teacher Archdiocese Of San Antonio Spring Branch, TX,
  • Identified children in need of extra support for emotional, health-related or developmental concerns and conceived improvement strategies.
  • Established indoor and outdoor safe play environments for toddler-age children.
  • Taught children foundational skills in colors, shapes and letters.
  • Organized and led activities to promote physical, mental and social development.
  • Collaborated with parents to develop and maintain strong support networks and build rapport to foster seamless communication.
  • Enhanced sensory abilities by giving children access to numerous textures and shapes.
  • Implemented hands-on, play-based strategies for experiential learning.
  • Introduced learning activities and imaginative play to teach children to explore.
  • Monitored children's play activities to identify additional learning opportunities or behavioral issues.
  • Observed behavioral issues to alert parents or guardians.
  • Supervised circle time, free play, outside play and learning and developmental activities.
  • Read aloud and played alphabet games to encourage early literacy.
  • Sparked creativity and imagination by helping children discover new things each day.
  • Escorted children on outings and trips to promote enrichment and maintain safety.
  • Controlled classroom environments with clearly outlined rules and positive reinforcement techniques.
  • Communicated with parents regularly to maintain student progress, schedule meetings and increase overall student happiness.
  • Observed children for signs of illness, injury, emotional disturbance, learning disorders and speech problems.
  • Maintained daily records of individual activities, behaviors, meals and naps.
  • Read stories to children and taught painting, drawing and crafts.
  • Observed children to record development.
  • Built and strengthened positive relationships with students, parents and teaching staff.
  • Planned and implemented lessons using various teaching strategies to meet diverse student needs.
  • Organized creative and fun activities, enhancing children's physical, emotional and social well-being.
  • Monitored student progress to ensure cooperation and growth.
04/2010 to 04/2019
Facility Manager Dlh Holdings Corp. San Antonio, TX,
  • Prioritized and performed routine maintenance to keep facility in excellent shape.
  • Held oversight of equipment maintenance, repairs and installations scheduling and work performed.
  • Managed and directed facility staff by handling assignment delegation and timely completion.
  • Maintained cleanliness and presentation standards to increase appeal of facility.
  • Assessed facility operations and employee activities to enforce and adhere to workplace safety regulations.
  • Inspected equipment, facility grounds, external building structure and systems on regular basis.
  • Enforced compliance with OSHA regulations and company policies.
  • Set goals and deadlines for department.
  • Surveyed facility to maximize safety and security.
  • Prepared and reviewed operational reports and schedules.
  • Acquired, distributed and stored supplies.
  • Collected, analyzed and prepared reports of statistical data to assess facility management objectives.
05/2005 to 04/2010
Head Cook Northeastern Vermont Regional Hospital Saint Johnsbury, VT,
  • Cut, chopped and sliced meat and produce to prepare for cooking.
  • Followed recipes and procedures to prepare, season and cook food products.
  • Taught kitchen staff about proper nutrition, food allergies and dietary issues.
  • Assessed inventory levels and placed orders to replenish goods before supplies depleted.
  • Checked freezer and refrigerator each day to verify proper functioning.
  • Cleaned and sanitized work stations and equipment, complying with regulatory procedures.
  • Improved performance of team members resulting in high-quality meals produced daily.
  • Modified existing recipes and created new recipes to meet changing nutritional content needs.
  • Communicated with kitchen employees, answered questions and offered insight into food preparations.
  • Kept kitchen, cooking utensils and storeroom clean and neat.
  • Operated variety of kitchen equipment to measure and mix ingredients.
  • Followed "first in, first out" rule with every food and beverage item, tossing outdated and expired food products.
  • Placed orders for food and supplies used for creating meals for 40 people.
  • Sanitized counters and utensils used for preparation of raw meat, poultry, fish and eggs.
  • Served as lead cook, guiding and assisting training of less experienced cooks.
  • Used proper cleaning supplies and methods to disinfect counters where raw meat, poultry, fish and eggs had been prepared.
  • Monitored temperatures of prepared food and cold-storage areas.
  • Prepared variety of foods according to exact instructions and recipe specifications.
  • Helped management stay on top of supply needs by sharing information about low or spoiled inventory.
  • Oversaw inventory and ordered ingredients to restock freezers, fridges and pantry.
  • Observed food safety and sanitation protocols to reduce germ spread.
  • Cleaned and sanitized kitchen equipment, utensils and work stations.
Education and Training
Expected in 06/1991 to to
High School Diploma:
Upper Sandusky High School - Upper Sandusky, OH

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Resume Overview

School Attended

  • Upper Sandusky High School

Job Titles Held:

  • Prior Authorization Specialist
  • Toddler Teacher
  • Facility Manager
  • Head Cook


  • High School Diploma

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