Prior Authorization Specialist resume example with 3+ years of experience
JessicaClaire
, , 100 Montgomery St. 10th Floor(555) 432-1000, resumesample@example.com
Summary
Talented Prior Authorization Representative with years of implementing strategies to secure authorizations for clinical procedures. Expert delivering continuous clinical quality improvement. Superb influencing skills to communicate with credibility, tact and diplomacy. Also, knowledgeable entry-level medical billing and coding experience.
Skills
Insurance information oversight
Understanding of medical terms
Precertification requirements
Telephone etiquette
Recordkeeping and data input
Teambuilding
Troubleshooting
Working collaboratively
Team management
Computer skills
Work ethic
Referral verification
Front desk operations
HIPAA guidelines
Records maintenance
Proficient in EMRs, authorization websites
Patient callbacks
Customer service
MS Office
Clerical
Authorizations knowledge
Experience
05/2019 to 11/2019Prior Authorization SpecialistDana-Farber Cancer Institute | Brighton, MA,
Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
Filing out data entry forms to ensure all criteria was clearly documented.
Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
03/2018 to 10/2018MEDICAL OFFICE ASSISTANTHca | Lexington, KY,
Answer multi-line phone system.
Assisted with referrals and prepared medical records for patients.
Maintained confidentiality of records relating to clients' treatment
Scheduled appointments for patients via phone and in person for both medical appointments and transportation.
04/2016 to 02/2018Senior Authorization SpecialistLandmark Health | Orchard Park, NY,
Answer multi-line phone system, schedule patients with multiple PCPs and specialists.
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.
Notified ordering providers of denied authorizations.
Coordinated resolutions for issues and appealed denied authorizations.
Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
Maintained files for referral and insurance information, entering referrals into system.
Clarified patient inquiries and questions to update patient account information in computer system.
Created master spreadsheet to record procedures, denials and approvals.
08/2015 to 04/2016Medical ReceptionistWaisbren Medicine | City, STATE,
Entered insurance, demographics and health history into patient database.
Called patients to confirm scheduled appointments and obtain additional details.
Checked patients in and out for appointments and collected co-payments.
Scheduled and followed up on patient appointments, collected and processed patient payments and maintained patient files.
Processed patient payments and scanned identification and insurance cards.
Protected patients by observing strict HIPAA guidelines.
Photocopied insurance cards, documented details and verified patient coverage for upcoming procedures or appointments.
Took messages from patients and promptly relayed to appropriate staff.
Answered multi-line phone system and directed callers to requested personnel and departments.
Greeted each patient pleasantly and offered desk sheet for easy sign-in.
Delivered high-quality administrative and customer service to sustain patient and work flows.
Carried out daily tasks by professionally communicating with physicians, nursing staff, technicians and medical assistants.
Retrieved faxes and uploaded documents to patient charts to assist clinical staff.
Straightened up waiting room to maintain neat and organized space.
Managed office phone lines by checking voicemail, returning calls and directing messages to team members.
Education and Training
Expected in 04/2021Career Diploma | Medical Billing And CodingAshworth College, Norcross, GAGPA:
Completed continuing education in Medical Billing and Coding
3.8 GPA
Honor Roll April 2021
DETHS Member
Expected in 05/2011Bachelor of Arts | Music EducationGeorgian Court University, Lakewood, NJ, GPA:
Major in Music Education
Accomplishments
Consistently maintained high customer satisfaction ratings.
Recognized as Difference maker and Difference maker of the year (2017) for outstanding performance and team contributions.
Promoted to Senior Authorization specialist due to exceptional work ethic and training other employees in authorizations that achieved better teamwork and a better workflow.
Additional Information
I will be sitting for my CPC-A certification exam with AAPC at the end of September. I will update my resume when I receive the certification.
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