Alexander Micahel Ilija Kulacic
Libertyville,IL
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. Compassionate professional motivated to positively impact program operations and participant success with diligent support. Well-trained the field with dedication to continuously enhancing strategies and optimizing assistance. Highly organized and hardworking with strong attention to detail.
Overview
14
14
year of professional experience
Work History
Prior Authorization Specialist
Illinois Bone and Joint Institute
Libertyville , IL
10/11/18 - 08.2024
- Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
- Reviewed claims submitted without valid pre-authorization codes and took corrective action when necessary.
- Identified areas where improvements can be made within the department by analyzing trends in denials and approvals.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Researched clinical criteria and determined eligibility for requested services based on plan provisions.
- Educated healthcare professionals on how to properly submit a request for pre-authorization.
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Maintained accurate records of all authorization activities in the database system.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
Front Desk Customer Service Representative
Staybridge Suites Hotel
Lincolnshire , 60069
11.2017 - 06.2018
- Assisted guests with special requests such as booking transportation or providing directions around town.
- Processed guest payments utilizing point of sale systems accurately and efficiently.
- Distributed key cards to guests upon check-in following established security protocols.
- Assisted customers with check-in and check-out process, answered questions about hotel services and amenities.
- Maintained a neat appearance throughout the shift adhering to company dress code standards.
- Coordinated with housekeeping staff regarding room cleaning schedules and occupancy levels.
- Performed daily audits of front desk activities including cash drawer balances, room status reports and other operational tasks.
Education
High School Diploma -
Adlai E. Stevenson High School
Lincolnshire, IL05-2011
Some College (No Degree) - Criminal Justice
College of Lake County
Grayslake, ILSome College (No Degree) - Marketing, Psychology, Television Broadcasting
Parkland Community College
Champaign, ILSkills
- Workflow Management
- Understanding of medical terms
- Billing Procedures
- Precertification requirements
- Patient Scheduling
- Proficiency in Software
- Effective communication skills
- Insurance Verification
- Data Entry
- Medical Terminology
- Critical thinking abilities
- Process improvement strategies
Timeline
Front Desk Customer Service Representative
Staybridge Suites Hotel
11.2017 - 06.2018
Prior Authorization Specialist
Illinois Bone and Joint Institute
10/11/18 - 08.2024
High School Diploma -
Adlai E. Stevenson High School
Some College (No Degree) - Criminal Justice
College of Lake County
Some College (No Degree) - Marketing, Psychology, Television Broadcasting
Parkland Community College
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