prior authorization specialist resume example with 6+ years of experience
Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Summary
Entry level medical assistant with 180 hours of hands-on experience within the field of Urgent Care.
Skilled administrative team member with in-depth understanding of medical standards, compliance requirements and operational procedures. Practiced problem-solver with friendly and caring mentality and excellent communication skills. Expertise in inventory management, customer service and inner-office operations. Detail-oriented Prior Authorization Specialist proudly offering over 3 years' experience managing medical documents meticulously. Polished professional known for working closely with insurance companies to alleviate denied claims and obtain necessary prior approvals for services. Offering the ability to multitask expertly in fast-paced environments. Driven and motivated with a desire to work closely with both customers and coworkers. Proficient at proofreading with excellent customer service skills.
Skills
Microsoft Word,
Electronic medical records
Communication
Administrative Skills
Client
Database
Documentation
Managing
Office
Microsoft Word
Computer skills
Flexible schedule
Read
Scheduling
Spanish
Typing 35 wpm
HIPAA guidelines
Patient callbacks
Telephone etiquette
Work ethic
Decision-making
Issue research
Precertification requirements
Insurance information oversight
Practitioner order verification
Understanding of medical terms
Team building
Critical thinking
Time management
Leadership
Planning
Relationship building
Technologically savvy
Patient scheduling
Planning & organizing
Reliable & trustworthy
Active listening
People skills
Organizational skills
Good work ethic
Troubleshooting
Conflict resolution
Education and Training
Plaza CollegeForest Hills, NYExpected in 2019 ā āAssociate Degree:Medical Assisting - GPA:
Plaza CollegeForest Hills, NYExpected in 01/2018 ā āGED: - GPA:
Experience
Oregon Medical Group - Prior Authorization Specialist Eugene, OR, 11/2019 - Current
Answered phone calls to provide assistance, information and medical personnel access to maximize office efficiency.
Took messages from patients and promptly relayed to appropriate staff.
Entered patient information, including insurance, demographic and health history into system to keep all records up-to-date.
Greeted callers with enthusiasm, answering all phone calls by second ring.
Explained eligibility details and affordability options to patients with kindness and respect.
Notified ordering providers of denied authorizations.
Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
Collaborated with internal departments to provide account status updates.
Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
Coordinated resolutions for issues and appealed denied authorizations.
Created master spreadsheet to record procedures, denials and approvals.
Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
Reviewed written correspondence, correcting grammatical and spelling errors.
Followed all Medicare, Medicaid, HIPAA and private insurance regulations and requirements.
Maintained high level of professionalism when speaking to doctors and insurance companies.
Clarified patient inquiries and questions to update patient account information in computer system.
Vitalant - Medical Assistant Neptune, NJ, 04/2019 - 07/2019
Recorded and updated patient information into database, as well as managing scheduling and follow-up appointments.
Administered patient blood and urine samples and prepared for lab processing.
Take and recorded patientās vital signs and biopsies including heart rate and blood pressure.
Prepared Blood- collecting equipment, draw blood, and safely store transport sample.
Performed electrocardiograms (EKG).
Ensured the cleanliness, sanitation and maintenance of the facilities, exam rooms and equipment.
Sunrise Senior Living - HHA Lansdale, PA, 01/2018 - 05/2019
Assist residents with bathing, dressing, feeding, lifting and transferring.
Provide grooming and mobility assistance to support daily living needs.
Clean house and prepared nutritious meals.
Offer caring companionship and emotional support.
Organize medications and reminded about taking each on scheduled.
Transport client to medical appointments and grocery shopping.
Sunrise Senior Living - HHA Mcclellan Air Force Base, CA, 08/2015 - 09/2017
Assisted resident with bathing, dressing, feeding, lifting and transferring.
Provided grooming and mobility assistance to support daily living needs.
Cleaned house, prepared nutritious meals, offered caring companionship and emotional support and transported client to medical appointments and grocery shopping.
Organized medications and reminded about taking each on scheduled.
Accomplishments
Certifications: Registered Medical Assistant, FEMA, OSHA, CPR and Mental Health First Aid Certified.
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