Bridget Woosley
Novelty,OH
Summary
Dynamic Prior Authorization Representative with extensive experience at Cleveland Clinic, adept at insurance verification and regulatory compliance. Proven ability to enhance patient eligibility processes while delivering exceptional customer service. Skilled in medical coding and team collaboration, ensuring timely and accurate authorizations that streamline patient care and support healthcare providers effectively.
Overview
20
20
years of professional experience
Work History
Prior Authorization Representative
Cleveland Clinic
Cleveland, OH
03.2015 - 04.2025
- Coordinated with healthcare providers to gather necessary patient information for prior authorization requests.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Communicated with internal teams regarding changes in policy or procedure related to prior authorization process.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Followed all Medicare, Medicaid, HIPAA and private insurance regulations and requirements.
- Followed up on pending prior authorization requests to ensure timely processing.
- Evaluated patient eligibility and benefits for requested procedures and medications.
- Utilized medical coding knowledge to accurately process and document authorization requests.
- Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
- Provided customer service to patients and healthcare providers, answering questions related to prior authorization and insurance coverage.
- Researched medical policies to ensure appropriate coverage of services.
- Reviewed prior authorization requests for completeness and accuracy.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Submitted prior authorization requests electronically or by phone to payers.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
Administrative Assistant
Technology Recovery Services
Highland Hts, OH
01.2005 - 03.2019
- Handled incoming and outgoing correspondence, including email, mail, and package deliveries, ensuring timely distribution.
- Processed invoices for payment using accounting software applications.
- Maintained inventory of office supplies and placed orders when necessary.
- Organized and maintained filing systems for physical and electronic documents, ensuring accuracy and confidentiality of records.
- Maintained compliance and discipline to be able to work in a highly regulated field due to government contracts.
- Handled confidential documents in an organized fashion according to established protocol.
Lunch Server
Mayfield City Schools
Mayfield Heights, OH
11.2005 - 06.2010
- Adhered to safe and proper storage guidelines for incoming supplies.
- Conducted daily inventory checks of all necessary supplies required for lunch service.
- Assisted in the preparation of salads, sandwiches, and other food items.
- Implemented food safety procedures, including proper storage and handling of ingredients.
- Maintained polite and professional demeanor to patrons to encourage inquiries and order placements.
- Managed multiple tasks simultaneously while maintaining a high level of accuracy.
- Participated in team meetings discussing new ideas for menu items or ways to improve overall customer satisfaction ratings.
- Participated in team meetings to discuss performance and areas for improvement.
- Maintained cleanliness and hygiene standards in food preparation and serving areas.
Education
High School Diploma -
Mayfield High School
Mayfield Heights, OH06-1988
Skills
- Prior authorization
- Insurance verification
- Medical coding
- Regulatory compliance
- Claim processing
- Patient eligibility
- Customer service
- Team collaboration
- Follow-up procedures
- Problem solving
- Critical thinking
- Teamwork
- Electronic health records proficiency
- Authorizations
- Confidentiality maintenance
- Follow-up skills
- Insurance authorization
References
References available upon request.
Timeline
Prior Authorization Representative
Cleveland Clinic
03.2015 - 04.2025
Lunch Server
Mayfield City Schools
11.2005 - 06.2010
Administrative Assistant
Technology Recovery Services
01.2005 - 03.2019
High School Diploma -
Mayfield High School
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