Britta Iano
Kennewick,WA
Summary
A seasoned Medication Prior Authorization Specialist, I leveraged my expertise in ICD-10 coding and exceptional communication skills at Restore Health and Pain Treatment Group to significantly enhance patient satisfaction. My proactive approach and dedication to process improvement strategies led to a notable increase in authorization approval rates, demonstrating my commitment to excellence and teamwork in a high-stakes environment.
Overview
15
15
years of professional experience
Work History
Medication Prior Authorization Specialist
Restore Health and Pain Treatment Group
Richland, WA
09.2023 - 08.2024
- 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.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- 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.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
- Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Continually updated knowledge on industry developments, ensuring adherence to best practices and relevant regulatory changes impacting the prior authorization process.
- Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.
- Participated in cross-functional initiatives to improve overall efficiency and effectiveness of the prior authorization process for all involved parties.
- Developed and maintained productive working relationships with healthcare providers.
- Identified trends in denials through data analysis, adapting strategies accordingly for improved success rates in obtaining approvals.
- Streamlined prior authorization processes by implementing efficient tracking systems.
- Improved patient outcomes by expediting authorization process for urgent and life-saving treatments.
- Enhanced efficiency in processing prior authorization requests by streamlining documentation procedures.
- Conducted thorough reviews of medical documentation to ensure compliance with payer policies and patient care standards.
- Improved provider satisfaction with timely communications regarding authorization status updates.
- Reduced turnaround time for prior authorization decisions by implementing more efficient review process.
- Increased approval rates for necessary medical procedures by providing detailed justifications and patient history during review process.
- Assisted in development of educational materials for patients and providers about prior authorization process.
- Participated in quality improvement initiatives aimed at reducing errors and enhancing patient satisfaction with authorization process.
- Supported healthcare providers by offering guidance on alternative treatment options when initial requests were denied.
- Streamlined submission of prior authorization requests, leading to faster patient access to needed treatments.
- Implemented tracking system for prior authorization requests to monitor progress and identify bottlenecks.
- Coordinated with pharmacy staff to ensure timely dispensing of medications following authorization approval.
- Collaborated with insurance companies to clarify coverage details and expedite review of complex cases.
- Advocated for patients by negotiating with insurance providers to cover necessary treatments not initially authorized.
- Fostered positive relationships with healthcare providers by ensuring transparent communication throughout authorization process.
- Contributed to policy updates by providing feedback on common challenges encountered during authorization process.
- Developed comprehensive database of insurance requirements and medication coverage to streamline prior authorization process.
- Maintained up-to-date knowledge of changing healthcare regulations and insurance policies to ensure accurate processing of requests.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
- Assisted clients with completion of applications and paperwork.
Medication Prior Authorization Specialist
Lynx Healthcare
Kennewick, WA
03.2018 - 06.2023
- 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.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- 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.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
- Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Continually updated knowledge on industry developments, ensuring adherence to best practices and relevant regulatory changes impacting the prior authorization process.
- Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.
- Participated in cross-functional initiatives to improve overall efficiency and effectiveness of the prior authorization process for all involved parties.
- Developed and maintained productive working relationships with healthcare providers.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
- Assisted clients with completion of applications and paperwork.
- Interviewed applicants and explained scope of different available benefits.
- Communicated with people from various cultures and backgrounds on application process.
- Maintained up-to-date knowledge of changing healthcare regulations and insurance policies to ensure accurate processing of requests.
- Developed comprehensive database of insurance requirements and medication coverage to streamline prior authorization process.
- Contributed to policy updates by providing feedback on common challenges encountered during authorization process.
- Analyzed trends in denied requests to identify opportunities for process improvement and training.
- Fostered positive relationships with healthcare providers by ensuring transparent communication throughout authorization process.
- Advocated for patients by negotiating with insurance providers to cover necessary treatments not initially authorized.
- Collaborated with insurance companies to clarify coverage details and expedite review of complex cases.
- Coordinated with pharmacy staff to ensure timely dispensing of medications following authorization approval.
- Implemented tracking system for prior authorization requests to monitor progress and identify bottlenecks.
- Streamlined submission of prior authorization requests, leading to faster patient access to needed treatments.
- Supported healthcare providers by offering guidance on alternative treatment options when initial requests were denied.
- Participated in quality improvement initiatives aimed at reducing errors and enhancing patient satisfaction with authorization process.
- Assisted in development of educational materials for patients and providers about prior authorization process.
- Facilitated cross-departmental training sessions to enhance understanding of prior authorization criteria and procedures.
- Increased approval rates for necessary medical procedures by providing detailed justifications and patient history during review process.
- Reduced turnaround time for prior authorization decisions by implementing more efficient review process.
- Improved provider satisfaction with timely communications regarding authorization status updates.
- Conducted thorough reviews of medical documentation to ensure compliance with payer policies and patient care standards.
- Enhanced efficiency in processing prior authorization requests by streamlining documentation procedures.
- Improved patient outcomes by expediting authorization process for urgent and life-saving treatments.
- Streamlined prior authorization processes by implementing efficient tracking systems.
- Identified trends in denials through data analysis, adapting strategies accordingly for improved success rates in obtaining approvals.
Lead Medication Technician
Highgate Senior Living
Yakima, WA
02.2010 - 02.2017
- Facilitated seamless transitions between shifts by providing thorough handoff reports to incoming staff members.
- Ensured proper medication storage and inventory management for optimal efficiency and compliance with regulations.
- Educated patients about potential side effects, interactions, and precautions related to their medications.
- Monitored patients for adverse reactions or complications from medications, initiating prompt interventions when necessary.
- Managed complex medication regimens including IV therapy, injections, and oral medications for diverse patient populations.
- Maintained accurate documentation of medication administration records, vital signs, and treatment plans for effective communication among the healthcare team.
- Promoted a culture of accountability through regular audits of medication administration practices and documentation.
- Participated actively in interdisciplinary team meetings, providing valuable insights on patients'' medication management and overall treatment plans.
- Trained new Medication Technicians, ensuring adherence to best practices and quality standards.
- Reduced medication errors by implementing a double-check system for high-risk drugs.
- Liaised effectively with pharmacists to clarify prescriptions, prevent potential drug interactions, or discuss alternative treatments as needed.
- Assessed patients'' understanding of their prescribed medications regimen during routine followups.
- Enhanced patient care by accurately administering medications according to physician orders and established protocols.
- Collaborated with healthcare team members to ensure comprehensive, coordinated care for each patient.
- Provided exceptional patient support, addressing concerns and answering questions regarding medications and treatments.
- Assisted in the development of streamlined medication administration procedures, resulting in increased accuracy and safety.
- Adapted quickly to changing patient needs by maintaining up-to-date knowledge on new medications and treatment protocols.
- Contributed significantly towards maintaining Joint Commission accreditation by adhering strictly to regulatory guidelines.
- Demonstrated proficiency with electronic health record systems for accurate inputting of patient information.
- Prepared medication doses accurately by following medication administration record (MAR) written by healthcare providers.
- Monitored medication storage area to maintain medication security and control.
- Documented medication administration into electronic medical records (EMR) to avoid duplication of medication dosages.
- Counted and recorded medication inventory routinely to maintain medication security and control.
- Reviewed medication orders for accuracy and completeness before administering medication.
- Reordered medication to maintain adequate supply.
- Unpacked, sorted, counted, and labeled all incoming medications to keep optimum inventory levels.
- Monitored patient responses to medication to report adverse reactions quickly.
- Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
- Identified and reported medication errors to avoid distributing wrong medication to patients.
- Reviewed patient progress to document effects of any prescribed medication.
- Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
- Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care.
- Administered psychotropic medications and anxiety education to patients to provide mental health care.
- Turned and repositioned patients to prevent bedsores.
- Explained treatment procedures, medications, and diets to inform patient and patient's family of care and progress.
- Interacted with patients and monitored vital signs during time of admission to report details to registered nurse.
- Assisted in maintaining conducive environment for residents by adhering to infection control policies.
- Assisted nursing staff with completing daily rounds, documenting vital signs and answering calls.
- Documented patient information and care activities in electronic health record.
- Completed activities of daily living for patients unable to self-care, and assisted those with limited mobility in completing tasks.
- Helped patients with self-feeding and assisted feeding, based on individual needs.
- Facilitated personal hygiene management, feeding and ambulation.
- Maintained patient stability by checking vital signs and weight and recording intake and outtake information.
- Responded to patient requests for supplies and personal comfort items such as extra blankets.
- Prevented cross-contamination by cleaning and sterilizing equipment.
- Helped patients complete range of motion exercises to prevent loss of function during care.
- Transported patients between rooms and appointments or testing locations.
- Observed patients under care conditions to help identify symptoms, responses to treatments and progress with goals.
- Upheld infection control and prevention policies across different patient-facing areas.
- Followed directions of licensed nurses to administer medications and treatments.
- Provided care to patients throughout lifespan with consideration of aging processes, human development stages and culture.
- Cared for clients with diagnoses such as respiratory failure, diabetes, Parkinson's disease and muscular dystrophy.
- Supported needs of Number+ residents under long-term care.
- Monitored patient specimen samples and test results to effectively alert supervisors of potentially unhealthy changes.
Education
None - Nursing
Washington State University
Pullman, WANone - Nursing
Yakima Valley Community College
Yakima, WACertified Nursing Assistant - Nursing
Certified Nursing Assistant
Yakima, WA06.2001
Graduate Certificate - Highschool Diploma
Naches Valley High School
Naches, WA06.1999
Skills
- Prior Authorization Process
- ICD-10 Coding Familiarity
- Medical Terminology
- Medical Appeals Handling
- Insurance Verification
- Authorizations
- Effective communication skills
- Medicare and Medicaid knowledge
- Data Entry
- HIPAA Compliance Knowledge
- Electronic Health Records Proficiency
- Medical terminology knowledge
- Physician order verification
- Benefit Coverage
- Understanding of medical terms
- Medical Office Procedures
- Professionalism and Ethics
- Process improvement strategies
- Billing Procedures
- Workflow Management
- Insurance procedures
- Understanding of insurance details
- Retro-Authorizations
- Records Maintenance
- Patient Confidentiality Compliance
- Pharmacy benefit management
- Patient Scheduling
- Provider Relations
- Claims processing experience
- Claim research
- Prescription Coordination
- Utilization Review Experience
- Critical thinking abilities
- Performance metrics analysis
- Proficiency in Software
- Issue Research
- Healthcare Regulations Understanding
- Quality Assurance Practices
- Clinical Documentation Improvement
- Eligibility Determination
- Problem-Solving
- Multitasking
- Telephone Etiquette
- Appointment Scheduling
- Documentation and paperwork
- Schedule Management
- Program knowledge
- Application support
- Resource information
- Application Review
- Teamwork and Collaboration
- Time Management
- Attention to Detail
- Problem-solving abilities
- Multitasking Abilities
- Reliability
- Excellent Communication
- Organizational Skills
- Team Collaboration
- Active Listening
- Effective Communication
- Adaptability and Flexibility
- Decision-Making
- Relationship Building
- Team building
- Task Prioritization
- Self Motivation
- Interpersonal Skills
- Analytical Thinking
- Goal Setting
- Professionalism
- Interpersonal Communication
- Time management abilities
- Continuous Improvement
- Adaptability
- Written Communication
- Professional Demeanor
- Problem-solving aptitude
Timeline
Medication Prior Authorization Specialist
Restore Health and Pain Treatment Group
09.2023 - 08.2024
Medication Prior Authorization Specialist
Lynx Healthcare
03.2018 - 06.2023
Lead Medication Technician
Highgate Senior Living
02.2010 - 02.2017
None - Nursing
Washington State University
None - Nursing
Yakima Valley Community College
Certified Nursing Assistant - Nursing
Certified Nursing Assistant
Graduate Certificate - Highschool Diploma
Naches Valley High School