Betty Lawson
Maineville,OH
Summary
Experienced with insurance authorization processes, ensuring efficient and timely approvals. Utilizes precise data entry and effective communication to streamline operations. Strong understanding of healthcare protocols and requirements, contributing to optimal patient care. Developed strong analytical and communication skills in high-paced healthcare environment. Demonstrated ability to manage complex tasks and collaborate effectively with diverse teams. Seeking to transition into new field where these transferrable skills can drive success and innovation.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Medical Insurance Authorization Specialist
Ensemble Health Partners
12.2018 - Current
- Collaborated with healthcare providers to ensure proper documentation for successful authorizations.
- Achieved higher accuracy rates in authorizations, utilizing attention to detail and organizational skills.
- Streamlined workflow processes for faster turnaround times, using data-driven approaches and continuous improvement techniques.
- Increased efficiency of the authorization process with effective communication among multidisciplinary teams.
- Developed strong working relationships with physicians'' offices resulting in a smoother flow of required documents when submitting requests.
- Streamlined insurance authorization processes by implementing efficient workflow strategies.
- Ensured compliance with industry regulations by staying up-to-date on policy changes and updates.
- Ensured continuity of care for patients by tracking expiring authorizations and initiating renewals as needed.
- Coordinated pre-authorization requirements for medical treatments or services, enhancing overall patient experience before appointments.
- Managed high-volume caseloads to meet strict submission deadlines, prioritizing tasks accordingly.
- Reduced claim denials by diligently reviewing and correcting errors in authorization submissions.
- Resolved complex authorization issues, working closely with patients and insurance companies to find solutions.
- Enhanced patient satisfaction rates through timely and accurate insurance verifications.
- Contributed to revenue growth, securing necessary authorizations for medical procedures promptly and accurately.
- Maintained comprehensive knowledge of various insurance plans, ensuring accurate information was provided during the authorization process.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Developed and maintained productive working relationships with healthcare providers.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Tracked referral submission during facilitation of prior authorization issuance.
Skills
- Prior authorization
- Strong communication skills
- HIPAA compliance
- Active listening
- Medical terminology proficiency
- Authorizations
- Critical thinking
- Insurance procedures
- Insurance verification
- Healthcare regulations
- Medical terminology knowledge
- Insurance verification expertise
Certification
CRCR-certified revenue cycle
Timeline
Medical Insurance Authorization Specialist
Ensemble Health Partners
12.2018 - Current
CRCR-certified revenue cycle
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