Detail-oriented Prior Authorization Specialist with extensive experience in administrative functions within fast-paced environments. Skilled in securing prior authorizations, managing documentation, and facilitating communication among patients, providers, and insurance companies. Proven problem-solving abilities enhance workflow efficiency and improve patient outcomes.
Overview
2
2
years of post-secondary education
15
15
years of professional experience
Work History
Prior Authorization Specialist
West Suburban Center for Arthritis
Waukesha
10.2011 - Current
Reviewed and processed prior authorization requests for various specialty medications and treatments.
Collaborated with healthcare providers to gather necessary documentation.
Tracked and expedited pending authorizations to ensure timely resolutions and minimize delays.
Maintained accurate records of authorization requests and outcomes.
Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
Cultivated relationships with external vendors to enhance pre-authorization service delivery.
Processed appeals in a timely manner as per policy guidelines.
Demonstrated knowledge of biosimilars, pharmacy benefit managers, and third-party payers in healthcare settings.
Provided patient with additional resources such as PAN Foundation and Copay Relief Fund.
Education
None - Business Management
Milwaukee Area Technical College
Milwaukee, WI
08.2006 - 10.2008
West Allis Central
West Allis , WI
Skills
Insurance verification
Data entry
Microsoft experience
Organization
Detail oriented
Multitasking
Problem solving
Customer advocacy
Communication
Affiliations
Spending time with family
Taking walks
Reading
Playing board games
Other
Spent 2 years as a military wife in Fort Hood Texas and raised our daughter