Carolyn Rowe
Millen,GA
Summary
Dynamic Prior Authorization Specialist with expertise from Cigna, adept at navigating complex insurance requirements and enhancing patient referral processes. Proven ability in medical coding and effective communication, ensuring compliance and improving authorization turnaround times. Committed to delivering exceptional service while maintaining patient confidentiality and fostering strong relationships with healthcare providers.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Cigna
04.2021 - 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.
- Verified eligibility and compliance with authorization requirements for service providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
Technical Support Representative
Whirlpool Call Center
Remotely
05.2016 - 02.2020
- Maintained and processed invoices, deposits, and money logs.
- Managed accounts payable and receivable activities, maintaining vendor relationships and positive cash flow.
- Handled payroll processing for employees, ensuring timely payment and adherence to tax regulations.
- Monitored incoming payments from clients, ensuring prompt application of funds against outstanding invoices.
- Posted daily receipts and payments in accordance with corporate protocols.
- Supported year-end closing procedures by preparing adjusting journal entries as needed.
- Reviewed and filed financial documents, coded accounting entries for data processing, and posted daily receipts and payments in accordance with all corporate protocols.
Lead Forklift Operator
NRS Global Partners
Pooler, GA
10.2009 - 06.2014
- Resolved issues related to damaged goods or misplaced items expeditiously, maintaining customer satisfaction levels.
- Communicated effectively with supervisors and peers alike, ensuring a cohesive team environment conducive to productivity.
- Improved warehouse efficiency by maintaining accurate inventory records and ensuring proper placement of products.
- Enhanced workplace safety by conducting regular equipment inspections and addressing potential hazards in a timely manner.
Education
Certified Phlebotomy Technician - Phlebotomy
National Associates of Phlebotomy Tech Professiona
Statesboro, GA08.2025
CNA - Nursing
Swainsboro Technical College
Millen, GA08.2003
GED - General Studies
Swainsboro Technical College
Millen, GA05.2003
Skills
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Insurance verification
- Authorizations
- Effective communication skills
- Patient referrals
- Data entry
- Electronic health records proficiency
- Medical terminology knowledge
- Benefit coverage
- Medical office procedures
- Professionalism and ethics
- Process improvement strategies
- Billing procedures
- Workflow management
- Retro-authorizations
- Insurance procedures
- Patient confidentiality compliance
- Utilization review experience
- Medical coding
- Proficiency in software
- Medical coding expertise
- Quality assurance practices
- Knowledgeable in software
- Critical thinking
- Clinical documentation improvement
- HIPAA compliance
- ICD-10 coding
- Healthcare regulations
- CPT coding
- Private insurance
- Medical billing procedures
- Insurance information oversight
- Outpatient surgery coding
- Precertification requirements
- Problem-solving
- Multitasking
- Telephone etiquette
- Appointment scheduling
- Documentation and paperwork
- Schedule management
- Resource information
- Application support
- Conflict resolution
- Data compilation
- Teamwork
- Teamwork and collaboration
- Customer service
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking Abilities
- Reliability
- Excellent communication
- Flexibility
- Active listening
- Effective communication
- Adaptability and flexibility
- Relationship building
- Decision-making
- Computer proficiency
- Documentation skills
- Team building
- Task prioritization
- Goal setting
- Analytical thinking
- Interpersonal skills
- Self motivation
- Resourcefulness
- De-escalation techniques
- Record keeping
- Adaptability
- Continuous improvement
- Time management abilities
Accomplishments
- Certificate of phlebotomy
Certification
- CNA
- Certification of phlebotomy
Timeline
Prior Authorization Specialist
Cigna
04.2021 - Current
Technical Support Representative
Whirlpool Call Center
05.2016 - 02.2020
Lead Forklift Operator
NRS Global Partners
10.2009 - 06.2014
Certified Phlebotomy Technician - Phlebotomy
National Associates of Phlebotomy Tech Professiona
CNA - Nursing
Swainsboro Technical College
GED - General Studies
Swainsboro Technical College