Catherine Wallace

Work History

Medical Records & Prior Authorization Specialist

Ohio Ent & Allergy

07.2019 - 03.2025

Uploaded physician progress notes, history, and physicals into electronic medical records.
Reviewed charts and flagged incomplete or inaccurate information.
Kept accurate log of requests for medical information and records.
Created new medical records and retrieved existing medical records by gathering appropriate record folders and contents and assigning and recording new record numbers.
Communicated effectively with staff, patients, and insurance companies by email and telephone.
Maintained patient confidence by keeping patient records information confidential.
Maintained patient records in compliance with security regulations.
Managed electronic medical records for 1000+ patients.
Obtained necessary signatures on information release forms to obtain medical and treatment records from other service providers.
Responded to patient inquiries to provide information and details of medical records.
Supported medical staff by providing organized and accurate medical records.
Maintained patient records systems by archiving, scaning and indexing important documents and files.
Scanned medical records in digital format for easy retrieval and accessibility.
Developed and maintained organized filing system for medical records to adhere to HIPAA regulations.
Printed and photocopied documents to provide patients with copies of medical records.
Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Fielded telephone inquiries on authorization details from plan members and medical staff.
Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
Verified eligibility and compliance with authorization requirements for service providers.
Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
Analyzed medical records and other documents to determine approval of requests for authorization.
Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
Responded to inquiries from healthcare providers regarding prior authorization requests.
Developed and maintained productive working relationships with healthcare providers.

Front End Medical Manager

Dr. John Ryan Rheumatology Miami Valley Hospital

02.2015 - 07.2019

Performed administrative duties such as faxing and filing confidential documents, answering telephones and responding to emails.
Used Epic to maintain and update patient database and staff records.
Confirmed patient appointments via telephone to inform of appropriate preparations needed prior to examination.
Followed up with doctors' offices to verify proper scheduled exams.
Served as central point of contact for all outside vendors.
Received and screened phone calls and emails.
Communicated scheduling changes to staff members, implementing proof-of-receipt to reduce errors.
Managed daily scheduling conflicts to reduce operational backlogs and support full shift-coverage.

Front Desk Medical Receptionist

Ohio Pain Solutions

08.2011 - 12.2015

Helped patients complete necessary medical forms and documentation.
Completed clerical duties and tasks for clinic administration.
Used computer programs and registration systems to schedule patients for routine and complex procedures.
Remained aware of provider schedules and scope of practice on evolving basis to organize and schedule appropriate care.
Checked patient insurance, demographic, and health history to keep information current.
Verified and updated demographic and other personal information for clients with respect to personal boundaries when asking for important details.
Coordinated patient scheduling, check-in, check-out and payments for billing.
Managed multi-line phone system and pleasantly greeted patients.
Adhered to strict HIPAA guidelines to protect patient privacy.
Transcribed phone messages and relayed to appropriate personnel.
Maintained current and accurate medical records for patients.
Answered phone calls and messages for [Number]-physician [Type] medical facility, scheduling appointments, and handling patient inquiries.
Greeted visitors and initiated triage processes for clients to streamline patient flow.
Managed office bookkeeping with insurance billing and patient payments.
Prepared and processed patient referrals and transfer requests.
Received and routed laboratory results to correct clinical staff members.
Conducted patient intake interviews, recording and documenting relevant information.
Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.

Office

Canal Street Tavern

01.2009 - 05.2011

Self-motivated, with a strong sense of personal responsibility.
Proved successful working within tight deadlines and a fast-paced environment.
Cultivated interpersonal skills by building positive relationships with others.
Worked effectively in fast-paced environments.
Managed time efficiently in order to complete all tasks within deadlines.
Responded to inquiries from callers seeking information.
Updated spreadsheets and databases to track, analyze, and report on performance and sales data.
Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
Liaised between clients and vendors and maintained effective lines of communication.
Interacted with vendors, contractors and professional services personnel to receive orders, direct activities, and communicate instructions.
Assisted coworkers and staff members with special tasks on daily basis.
Opened and properly distributed incoming mail to promote quicker response to client inquiries.
Volunteered to help with special projects of varying degrees of complexity.
Managed filing system, entered data and completed other clerical tasks.
Continually sought methods for improving daily operations, communications with clients, recordkeeping, and data entry for increased efficiency.

Summary

Overview

Work History

Medical Records & Prior Authorization Specialist

Front End Medical Manager

Front Desk Medical Receptionist

Office

Education

Associate of Applied Science -

Skills

Certification

Timeline

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