Andrea Brown
Roy,UT
Summary
Dynamic Prior Authorization Specialist with proven success at Rotech Healthcare, adept at securing authorizations through effective communication and comprehensive documentation. Demonstrated expertise in medical terminology and insurance verification, achieving a high success rate in approvals while enhancing customer service and maintaining compliance with healthcare regulations.
Experienced with navigating healthcare insurance systems to secure treatment approvals. Utilizes keen attention to detail and extensive knowledge of medical coding to streamline processes. Strong understanding of insurance guidelines and patient advocacy to ensure optimal outcomes.
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over Number years of managing documentation. Considered team player with exemplary multitasking skills.
Organized professional knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in medical offices, communicating effectively orally and through writing and developing prior authorization workflows.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Rotech Healthcare
07.2024 - Current
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
- Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
- Continually updated knowledge on industry developments, ensuring adherence to best practices and relevant regulatory changes impacting the prior authorization process.
- Identified trends in denials through data analysis, adapting strategies accordingly for improved success rates in obtaining approvals.
- Reduced turnaround time for prior authorization decisions by implementing more efficient review process.
Lead Chef
Harmons Grocery Store
06.2013 - 07.2021
- Demonstrated exceptional leadership skills while supervising a team of chefs and kitchen staff members during peak service hours.
- Continuously improved culinary techniques through professional development opportunities such as workshops, seminars, and industry conferences.
- Increased customer satisfaction by consistently delivering high-quality dishes in a timely manner.
- Assisted with marketing efforts through participation in local events such as cooking demonstrations and charity fundraisers, raising brand awareness within the community.
- Reduced staff turnover through effective training, mentoring, and performance evaluations.
Education
Certificate Of Technical Studies - Medical Billing And Coding
Ogden Weber Technology
Ogden, UT02.2025
Skills
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Authorizations
- Insurance verification
- Effective communication skills
- Data entry
- Electronic health records proficiency
- Physician order verification
- Medical terminology knowledge
- Benefit coverage
- Medical office procedures
- Professionalism and ethics
- Billing procedures
- Process improvement strategies
- Insurance procedures
- Workflow management
- Retro-authorizations
- Records maintenance
- Patient confidentiality compliance
- Provider relations
- Claim research
- Utilization review experience
- Medical coding
- Clinical documentation improvement
- Knowledgeable in software
- Proficiency in software
- HIPAA compliance
- ICD-10 coding
- Healthcare regulations
- CPT coding
- Medical billing procedures
- Private insurance
- Practitioner order verification
- Precertification requirements
- Eligibility determination
- Multitasking
- Problem-solving
- Documentation and paperwork
- Teamwork
- Customer service
- Time management
- Attention to detail
- Reliability
- Excellent communication
- Organizational skills
- Team collaboration
- Flexibility
- Computer proficiency
- Continuous improvement
Certification
- Medical billing certification
Timeline
Prior Authorization Specialist
Rotech Healthcare
07.2024 - Current
Lead Chef
Harmons Grocery Store
06.2013 - 07.2021
Certificate Of Technical Studies - Medical Billing And Coding
Ogden Weber Technology
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