Highly accomplished medical professional with a diverse background in medical staff management, medical and business office management/administration, and insurance authorization. Proven problem-solving, analytical, and creative thinking skills in a complex environment.
Type 50+ WPM
Electric Medical Records
20+ years working in healthcare which includes 6 in Oncology
Quality improvement competency
Provider Network Manager , 03/2014 to Current Company Name – City, State
Responsible for provider contracting and maintaining positive working relationships with all participating providers and payers.
Serve as a liaison between the provider, payer and NCH's internal departments to address and resolve issues.
Responsible for conducting provider in-services and educating network providers and supporting office staff on the process and policies of NCH. Provide ongoing support to the staff and providers.
Meet with groups quarterly either in person or virtually to go over the data and discuss any needs from the group.
Constant communication with payer representatives and help with member transitioning.
Help implement new markets by working with payers in targeting groups, reaching out to the providers, setting up provider meetings and conducting training to the staff.
Prior Authorization Lead, 05/2012 to 02/2013 Company Name – City, State
Oversaw the chemotherapy authorization department and obtain prior authorizations.
Managed and trained the staff.
Supported the Claims and Denials departments to ensure all authorizations were obtained and no claim denials for "no auth".
Prior Authorization Supervisor, 12/2011 to 04/2012 Company Name – City, State
Obtained prior authorizations for chemotherapy services.
Worked with various insurance companies to verify and obtain authorizations on a daily basis.
Specialist, Prior Authorization/ Supervisor, 08/2010 to Current Company Name – City, State
Worked collaboratively with clinical areas to ensure prompt prior authorization and insurance/benefit verification for oncology-specific services, procedures and treatments.
Specialized in obtaining STAT authorizations.
Developed key relationships internally and externally with insurance agents to ensure fast turn-around times.
Back up front desk personnel.
All aspects of Medical Records.
Audit prior authorizations for department personnel.
Residency Coordinator, 08/2008 to 01/2010 Company Name – City, State
appropriate orientation and education to 3rd and 4th year
residents, and maintained daily operates within department.
Set up appropriately
lectures and schedules.
Maintained department operational functions,
including assisting where necessary, managing calendars, and maintenance of
faculty credentialing files.
Diploma: Medical Office Management, 1995 SAWYER BUSINESS COLLEGE - City, State
Coursework in Healthcare Administration
Coursework in Health Services Administration and Business
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SAWYER BUSINESS COLLEGE
Job Titles Held:
Provider Network Manager
Prior Authorization Lead
Prior Authorization Supervisor
Specialist, Prior Authorization/ Supervisor
Diploma : Medical Office Management , 1995
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