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Prior Authorization Specialist Resume Example

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JC
Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000, resumesample@example.com
Professional Summary

Outgoing, well organized, and dedicated administrative professional with a proven track record of providing exceptional customer service, building strong working relationships with fellow staff, providers, patients and their families. Areas of expertise include but not limited to patient/parent education, appointment scheduling, prior authorizations, insurance, billing, and a solid background in health record management. Motivated and seeking a position in a company where there is opportunity for growth and advancement.

Skills
  • Personable and positive attitude
  • Professional
  • Accurate and detailed
  • Willing to learn
  • Dependable
  • Medical coding
  • Medical terminology
  • Service-oriented
  • Ability to accept and learn from criticism
  • Resilient
Work History
08/2020 to Current Outside Scheduler Dana-Farber Cancer Institute | Brookline, MA,
  • Reached out to insurance carriers to obtain prior authorization for testing and procedures.
  • Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
  • Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
  • Interacted with physicians and other healthcare staff to ask questions regarding patient services.
  • Resourcefully used various coding books, procedure manuals and on-line encoders.
02/2019 to 06/2020 Prior Authorization Specialist Washburn Center | Brooklyn Park, MN,
  • Processed prior auth requests for MRI, CT, PET scans, all out patient procedures, therapies, durable medical equiptment , and inpatient hospital stays in accordance with applicable plan guidelines
  • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures
  • Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response
  • Escalated requests for non-standard services to the Medical director to review for medical appropriateness
  • Edited letters and written material for correspondence
  • Facilitated organized record retrieval and access by maintaining filing system for both in-house and discharged residents
  • Fielded telephone inquiries on authorization details from plan members and medical staff
  • Input all patient data regarding claims and prior authorizations into system accurately
  • Created and maintained spreadsheets detailing all medical procedures, including applicable denials and approvals
01/2010 to 12/2018 Front Office Assistant Cavender's | Snellville, GA,
  • Greeted daily visitors upon arrival
  • Handled incoming and outgoing correspondence, including faxes, phone, email and live chat
  • Scheduled and managed appointments
  • Treatment coordinating
  • Managed patient health and financial records, including scanning physical files into digital records
  • Verified insurance coverage and benefits
  • Insurance billing
  • Processed daily and monthly payments. Preformed account reconciliations and resolved variances
  • Back office and chair-side assisting
  • Charting and clinical documentation
  • Worked with Dentrix, Ortho2, Paperless Technology, Demand Force and Referral Raven software programs
  • Supervised clerical personnel, trained new employees, assisted in team building and event planning
  • Analyzed patient and family feedback to identify opportunities for staff recognition as well as area's for improvement
  • Daily tidied and organized office to maintain company appearance standards. Cleaned office once a week and decorated monthly
  • Performed monthly inventory and maintained office and medical supply counts
  • Marketing
  • Administrative support
10/2002 to 04/2007 Sales Associate Center For Human Development | La Grande, OR,
  • Processed incoming products into the store
  • Stocked shelves and supplies. Organized displays. Decorated display beds and store front display window
  • Prepared outgoing shipments
  • Educated customers on different products, product care, and answered questions regarding store policies
  • Liaised with customers and recommended specific products and specials in alignment with individual needs, requirements and specifications
  • Implemented up-selling strategies, encompassing recommendation of accessories and complementary purchases
  • Analyzed and properly processed product returns and assisted customers with other selections
  • Sourced hard to find items at other store locations to meet customer needs
  • Trained new associates in product knowledge, selling techniques and company procedures
  • Managed Bridal Registry
  • Was part of yearly inventory team
  • Operated a cash register for cash, check, debit and credit and maintained accurate drawers
05/1996 to 05/2000 Medical Records Specialist Banner Health | City, STATE,
  • Ensured that copies of records only included the information that had been requested
  • Accurately pulled patient records in a timely manner
  • Maintained relationships with medical providers, suppliers and reporters
  • Reviewed recordkeeping procedures for patients and doctors
  • Communicated effectively with staff, patients and insurance companies by email and telephone
  • Kept an accurate log of all requests for medical information and records
  • Reviewed documentation for compliance with requirements and accuracy of information
  • Verified signatures and checked medical charts for accuracy and completion.
Education
Expected in 08/2021 | Medical Coding Herzing University, Menomonee Falls, WI, GPA:
Expected in | Maricopa Community Colleges - Glendale Community College, Glendale, AZ GPA:
Expected in | Maricopa Community Colleges - Mesa Community College, Mesa, AZ GPA:
Expected in 05/1997 High School Diploma | Red Mountain High School, Mesa, AZ GPA:
Certifications
  • Registered to sit for the CPC (Certified Professional Coder) exam with the AAPC in October 2021.
  • BLS certified through American Heart Association.
References

Lori McElroy, RN Health Services Manager (480) 620-5571

Debbie Mililow, RN Case Manager (602) 527-6556

Stacy Anderson, Account Manager (480) 921-8944 , ext.3213

Cathi Sabin, Advanta Supervisor (480) 861-3712

Millicent Vega, RN (661) 364-2442

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Resume Overview

School Attended
  • Herzing University
  • Maricopa Community Colleges - Glendale Community College
  • Maricopa Community Colleges - Mesa Community College
  • Red Mountain High School
Job Titles Held:
  • Outside Scheduler
  • Prior Authorization Specialist
  • Front Office Assistant
  • Sales Associate
  • Medical Records Specialist
Degrees
  • High School Diploma