Senior Insurance Authorization Specialist III Resume Example
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SENIOR INSURANCE AUTHORIZATION SPECIALIST III
Professional Summary
Experienced Senior Insurance Authorization Specialist with over 25 years of experience in healthcare industry including pre-authorization, referral processing and scheduling. Excellent reputation for organization, problem resolution, improving customer satisfaction and overall operational improvements. Strong rapport with internal and external customers based on knowledge, professionalism, strong work ethic and integrity. Motivated to learn, grow and excel in the healthcare operations industry.
Skills
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Work History
Senior Insurance Authorization Specialist III, 01/2017 to 09/2020
Cvs Health – High Point , NC
Cvs Health – High Point , NC
- Conduct clinical review for verification to meet insurance guidelines including benefit verification and obtain referral and pre-authorization per insurance regulations and policy criteria.
- Communicate efficiently and effectively with staff, including members of operations, finance and clinical departments.
- Track all pending authorizations and referrals to resolve discrepancies and avoid revenue loss.
- Demonstrate imperative flexibility and problem solving skills to manage full case load of 16 specialty based providers with varying insurance industry laws, regulations and policy language guidelines.
- Research and resolve both routine and complex issues.
- Display consistent, positive attitude towards customers, peers and other personnel, even during high-stress situations.
- Created and implemented successful training and development programs assuring continuous training to employees to promote long-term excellence.
- Coordinated with contracting department to resolve payer issues.
- Maintained confidentiality of patient finances, records and health statuses.
- Processed eligibility and benefits verification, authorization internal and external referral requests.
- Communicated effectively with staff, including members of operations, finance and clinical departments.
Ancillary Coordinator, 10/2014 to 12/2016
Qualfon – Highland Park , MI
Qualfon – Highland Park , MI
- Coordinated Ancillary Department supporting and training organization over multiple locations to ensure and support seamless operations to over 500 employees.
- Streamlined operations to efficiently process all medical equipment and supply orders including navigating medical policy language, obtaining authorization, shipping of orders, submission of claims in timely matter to ensure reimbursement and consolidate claims data.
- Executed introduction and set up of internal pharmacy to meet high demands of specialty compounding services, meeting industry and federal guidelines.
- Established and implemented company wide training, development and education to introduce and support all ancillary services and products.
- Provided primary customer support to internal and external customers in fast-paced environment ensuring excellent customer service.
- Coordinated with contracting department to resolve payer issues.
- Conduct clinical review for verification to meet insurance guidelines including benefit verification and obtain pre-authorization per insurance regulations and policy criteria.
Lead Authorization Specialist, 05/2005 to 10/2014
Advanced Pain Management – City , STATE
Advanced Pain Management – City , STATE
- Process eligibility, benefits verification and authorization requests.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Determined clinical appropriateness of procedures based on policy language to protect organization and minimize risk.
- Maintained strong knowledge of medical terminology to better understand services and procedures.
- Established efficient workflow processes, monitored daily productivity and implemented modifications to improve overall effectiveness of personnel and activities.
- Assisted authorization team of 15 team members with day-to-day operations and complex problems by applying motivational and analytical strategies.
Customer Service Representative, 03/2004 to 05/2005
United Health Group – City , STATE
United Health Group – City , STATE
- Assessed medical records to determine extent of third party liability and assist in claims payment recovery.
- Managed customer calls effectively and efficiently in complex, fast-paced and challenging call center environment to support subrogation team.
- Provided primary customer support to internal and external customers in fast-paced environment.
- Seamlessly adapted to changing environment while handling multiple demands and priorities effectively
- Increased efficiency and productivity by promoting adherence to operational best practices and company policies.
- Analyzed information gathered by investigation and report findings.
- Answered constant flow of customer calls with up to 540 calls per week.
Education
GEDHSED - City
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Resume Overview
School Attended
- HSED
Job Titles Held:
- Senior Insurance Authorization Specialist III
- Ancillary Coordinator
- Lead Authorization Specialist
- Customer Service Representative
Degrees
- GED
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