Alicia Bernhard
Derby,NY
Summary
Dynamic Sr. Prior Authorization Representative with expertise in staff training and development. Proven ability to mentor team members and enhance collaboration, resulting in streamlined operations and improved authorization outcomes.
Overview
21
21
years of professional experience
Work History
Sr Prior Auth Representative
RPCI Oncology PC
Williamsville, New York
09.2023 - Current
- Processed prior authorization requests for medical services and procedures.
- Reviewed clinical documentation for accuracy and completeness.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Communicated with healthcare providers to clarify patient information.
- Collaborated with insurance companies to expedite approval decisions.
- Monitored status of authorization requests through internal systems.
- Maintained detailed records of all authorization activities and communications.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Assisted team members in resolving complex authorization issues efficiently.
- Trained new team members on company procedures and best practices.
- Facilitated communication between departments to enhance collaboration.
- Monitored team performance and provided constructive feedback regularly.
- Offered training and support to keep team members motivated and working toward objectives.
Front Office Team Lead
Trinity Cardiology
Orchard Park, New York
09.2021 - 08.2023
- Supervised front office operations for a leading cardiology practice.
- Trained and mentored front office staff on best practices and procedures.
- Coordinated patient scheduling to optimize clinic workflow and reduce wait times.
- Ensured that all front desk staff adhered to company policies and procedures regarding guest check-in and check-out processes.
- Resolved escalated issues between guests and other departments in a professional manner.
- Analyzed data from daily activity logs and prepared weekly performance summaries for management review.
Upfront Review Supervisor
Lincare
Blasdell, NY
02.2005 - 06.2019
- Supervised daily operations to ensure efficient workflow and team productivity.
- Coordinated staff schedules to optimize resource allocation and coverage.
- Monitored employee productivity to provide constructive feedback and coaching.
- Addressed employee concerns promptly to foster a positive workplace culture.
- Facilitated team meetings to discuss goals, challenges, and operational updates.
- Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions.
- Recruited, hired, trained, mentored, coached, and evaluated staff.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Reviewed clinical documentation for accuracy and completeness.
- Coordinated with other departments to obtain additional information needed for prior authorization.
Education
High School Diploma -
Lake Shore Central High School
Angola, NY06-2005
Skills
- Prior authorization processing
- Clinical documentation review
- Patient insurance verification
- Peer-to-peer scheduling
- Data analysis
- Staff training and development
- Leadership skills
- Effective communication
- Customer relationship management
- Problem solving
Timeline
Sr Prior Auth Representative
RPCI Oncology PC
09.2023 - Current
Front Office Team Lead
Trinity Cardiology
09.2021 - 08.2023
Upfront Review Supervisor
Lincare
02.2005 - 06.2019
High School Diploma -
Lake Shore Central High School