Summary
Overview
Work History
Education
Skills
Languages
Timeline
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Brenda Dobbins

Tonganoxie,KS

Summary

Client-centered Eligibility Specialist with a career spent accurately managing records, handling appointment scheduling and overseeing other administrative tasks in fast-paced settings. Bilingual individual committed to engaging others and delivering exceptional service. Ready to tackle new challenges in an office-based environment. 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. Trustworthy professional offering a keen understanding of the latest insurance requirements for prior authorizations. Determined Prior Authorization Specialist boasting extensive claim researching and effective collaboration skills with other members of the office staff. Detail-oriented Prior Authorization Specialist proudly offering over 4 years' experience managing medical documents meticulously. Polished professional known for working closely with insurance companies to alleviate denied claims and obtain necessary prior approvals for services. Multitasks expertly in fast-paced environments. Demonstrative Eligibility Specialist proudly offering over 4 years' experience assisting others with enrollment and program services. Polished professional known for interactions that are fair, compassionate and respectful. Promoting issue resolution expertise in fast-paced environments. Reliable professional offering an extensive career promoting positive customer experiences. Sharp Eligibility Specialist boasting expertise in managing and eligibility information for members and groups. Compassionate Prior Authorization Specialist motivated to positively impact program operations and participant success with diligent support. Well-trained in Radiology Authorizations, Pain Clinic , Interventional Radiology, Infusions, Scheduling, Pre Registration with dedication to continuously enhancing strategies and optimizing assistance. Highly organized and hardworking with strong attention to detail. Dependable Prior Authorization Specialist with a career spent handling various administrative responsibilities in fast-paced settings obtaining prior authorization information for patients. Ready to tackle new challenges in an office-based environment. Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking entry-level opportunities to expand skills while facilitating company growth. Hardworking employee with customer service, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience. Ambitious, career-focused job seeker, anxious to obtain an entry-level Prior Authorization Specialist position to help launch career while achieving company goals. Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Hardworking and reliable Prior Authorization Specialist with strong ability in multitask. Offering Scheduling and Prior Authorization. Highly organized, proactive and punctual with team-oriented mentality. Detail-oriented prior authorization specialist proudly offering several years' experience managing medical documents meticulously. Polished professional known for working closely with insurance companies to alleviate denied claims and obtain necessary prior approvals for services. Multitasks expertly in fast-paced environments. Analytical professional proficient in information gathering, report preparation and data compilation capabilities. In-depth knowledge of insurance coverage forms, procedures, and policies. Accommodating and logical individual skillful in creating customized requests for each client. 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. Accomplished professional offering great communication and customer service skills. Reliable and dedicated when working alone or as part of team. Hardworking medical administrative professional offers great people skills, organized file management and deep understanding of patient protections. Enhances office operations by staying on top of patient and staff needs. Experience with electronic recordkeeping and insurance documentation. Successful health information professional accomplished in maintaining complex and comprehensive records systems. Enhanced operations by identifying and recommending upgrades. Fully versed in medical terminology and code classifications.

Overview

34
34
years of professional experience

Work History

Prior Authorization Specialist/Financial Councello

Providence Medical Center
Kansas City, KS
05.2019 - 03.2024
  • Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
  • Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
  • Informed applicants of other agencies providing useful or related assistance.
  • Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
  • Advised provider offices on proper coding practices that are necessary for successful claim submission.
  • Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
  • Answered questions and responded to inquiries to deliver high level of service to patients.
  • Notified ordering providers of denied authorizations.
  • Maintained files for referral and insurance information, entering referrals into system.
  • Processed appeals in a timely manner as per policy guidelines.
  • Collaborated with internal departments to provide account status updates.
  • Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
  • Reviewed claims submitted without valid pre-authorization codes and took corrective action when necessary.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
  • Educated healthcare professionals on how to properly submit a request for pre-authorization.
  • Ensured compliance with state and federal regulations pertaining to prior authorizations.
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
  • Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
  • Granted, modified, denied, or terminated assistance based on key information and eligibility determination.
  • Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
  • Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
  • Researched clinical criteria and determined eligibility for requested services based on plan provisions.
  • Clarified patient inquiries and questions to update patient account information in computer system.
  • Reviewed prior authorization requests to ensure accuracy and completeness of required information.
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Analyzed utilization data reports for utilization management purposes.
  • Coordinated resolutions for issues and appealed denied authorizations.
  • Identified areas where improvements can be made within the department by analyzing trends in denials and approvals.
  • Interpreted benefit language in order to determine covered services under each plan type.
  • Conducted interviews with applicants, explaining benefits process and which programs were available.
  • Maintained accurate records of all authorization activities in the database system.
  • Conducted quality assurance audits of prior authorization processes according to established standards.
  • Maintained positive working relationship with fellow staff and management.
  • Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
  • Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
  • Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
  • Proofread documents carefully to check accuracy and completeness of all paperwork.
  • Coordinated with other departments to obtain additional information needed for prior authorization.
  • Assisted with developing policies and procedures related to prior authorizations.
  • Facilitated communication between providers, payers and health plans regarding prior authorization processes.
  • Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
  • Developed relationships with external vendors providing pre-authorization services.
  • Explained eligibility details and affordability options to patients with kindness and respect.
  • Used to input claim, prior authorization and other important medical data into system.
  • Provided guidance to providers regarding the prior authorization process.
  • Approached customers and engaged in conversation through use of effective interpersonal and people skills.
  • Answered 100 calls per shift to assist with customer questions and concerns.1
  • Used Epic to input claim, prior authorization and other important medical data into system.
  • Identified needs of customers promptly and efficiently.
  • Worked with cross-functional teams to achieve goals.
  • Maintained updated knowledge through continuing education and advanced training.
  • Achieved cost-savings by developing functional solutions to problems.
  • Exceeded customer satisfaction by finding creative solutions to problems.
  • Collaborated with cross-functional team to define features and build powerful and easy-to-use products and customer-facing workflow tools.
  • Maintained open communication with team members and stakeholders, resulting in successful project outcomes.
  • Understood and followed oral and written directions.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations.
  • Assisted with customer requests and answered questions to improve satisfaction.
  • Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
  • Prioritized and organized tasks to efficiently accomplish service goals.
  • Collaborated with others to discuss new opportunities.
  • Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
  • Answered 100 calls per shift to assist with customer questions and concerns.
  • Provided financial counseling to clients on budgeting, credit management, and debt repayment strategies.

Outpatient Registration Clerk

Providence Medical Center
Kansas City, KS
01.2009 - 01.2012
  • Greeted patients and collected registration forms, insurance cards, and other pertinent information for check-in process.
  • Verified patient demographics and insurance eligibility prior to services being rendered.
  • Assisted with incoming phone calls from existing and new patients.
  • Answered questions regarding hospital policies and procedures.
  • Scanned all documents into patient's electronic medical record.
  • Processed co-payments in a timely manner according to established protocols.
  • Accurately entered patient data into the EMR system in a timely fashion.
  • Ensured that all required consents were obtained prior to treatment or procedure.
  • Provided customer service support to patients when registering at the facility.
  • Collaborated with clinical staff on any discrepancies found while registering patients.
  • Assisted with answering billing inquiries from patients or their representatives.
  • Maintained accurate records of patient registration activities in accordance with HIPAA regulations.
  • Utilized various software programs such as scheduling systems, financial systems., to complete daily tasks.
  • Performed cashiering duties including taking payments for services rendered and issuing receipts.
  • Resolved issues related to incorrect demographic information or payment discrepancies.
  • Participated in training sessions related to departmental processes and procedures.
  • Responded to incoming department phone calls and directed callers to appropriate team members based on need.
  • Provided assistance to other departments within the organization as needed.
  • Asked various questions from clients to obtain the information necessary for paperwork.
  • Processed cash, debit and credit card payments for services rendered and printed receipts detailing services.
  • Welcomed patients to facility and assisted with registration sign-in process.
  • Adhered to HIPAA guidelines and maintained integrity of hospital policies and procedures.
  • Worked with nurses and other clinic staff to process patients and direct to appropriate departments.
  • Carefully checked insurance information for benefits coverage and input pre-authorization documents into system.
  • Registered patients for outpatient procedures and emergency services.

Cusotmer Service

bcbs of kansas city
Kansas City, MO
01.1990 - 12.1993
  • Answered customer inquiries and provided accurate information regarding health insurance.
  • Assisted clients in understanding their benefits and eligibility criteria by providing detailed information and support.
  • Developed and implemented strategies to ensure compliance with benefit regulations and policies.

  • Processed enrollment forms, changes in status forms, terminations and other benefit documents in a timely manner.
  • Resolved discrepancies between employer contributions and payroll deductions for benefits programs.
  • Provided customer service support to employees regarding questions or concerns about their benefits packages.
  • Monitored open enrollments to ensure accuracy of employee selections and that deadlines were met.
  • Responded promptly to inquiries from current or prospective participants regarding benefits programs or services offered through the company's plans.
  • Assisted employees with filing claims for medical expenses or other eligible services covered by their plans.
  • Coordinated with external providers such as insurance companies or third-party administrators to resolve issues related to eligibility requirements or payment processing.
  • Analyzed existing benefit offerings for cost effectiveness and recommended changes where appropriate.
  • Communicated effectively via email, phone and face-to-face with plan participants to resolve issues pertaining to health and welfare benefits.
  • Reviewed employee enrollments to verify accuracy, inputting information into company database.
  • Mastered state and Federal benefit laws Including ERISA, FMLA, COBRA, HIPPA and 401k administration.

Education

High School Diploma -

Tonganoxie High School
Tonganoxie, KS
01.1981

Skills

  • Data Entry
  • Proficiency in Epic
  • Medical Terminology
  • Patient Scheduling
  • Precertification Requirements
  • Issue Research
  • Insurance Procedures
  • Practitioner Order Verification
  • Records Maintenance
  • Insurance Information Oversight
  • Patient Referrals
  • Knowledgeable in
  • Knowledgeable in Epic, Windows, Insurance Company Authorization Platforms, RAD MD, UHC, BCBS, HUMANA, AIM, UMR, CLEARANCE, EVICORE, AVAILITY, HEALTH HELP, TRICARE, COHERE, MEDICAID, MEDICARE, CARE CREDIT, PRIMIRA, INFINITT, SUNFLOWER,
  • Effective Communication Skills
  • Medical Coding
  • Understanding of Medical Terms
  • Telephone Etiquette
  • Application Assessment
  • Data Compilation
  • Application Support
  • Application Review
  • Eligibility Determination
  • Payment Collection
  • Applicant Support and Service
  • Recordkeeping and Data Input
  • Documentation and Paperwork
  • Referral Coordination
  • Appointment Scheduling

Languages

English
Professional

Timeline

Prior Authorization Specialist/Financial Councello

Providence Medical Center
05.2019 - 03.2024

Outpatient Registration Clerk

Providence Medical Center
01.2009 - 01.2012

Cusotmer Service

bcbs of kansas city
01.1990 - 12.1993

High School Diploma -

Tonganoxie High School
Brenda Dobbins