Cathy Gelzer
Bowman,South Carolina
Summary
Dynamic Prior Authorization Specialist with extensive experience at MUSC Hospital, adept at navigating insurance verification and precertification requirements. Proven track record of reducing turnaround times and achieving high success rates in authorizations through effective communication and comprehensive documentation. Strong understanding of medical terminology and patient confidentiality compliance, ensuring optimal patient care and satisfaction.
Overview
35
35
years of professional experience
Work History
Prior Authorization Specialist
MUSC Hospital
Orangeburg, SC 29118
03.2023 - 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.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Input all patient data regarding claims and prior authorizations into system accurately.
Patient Counselor
Regional Medical Center Of Orangeburg & Calhoun Counties
Orangeburg, SC 29118
01.1997 - 01.2010
- Answered incoming calls, scheduled appointments and filed medical records.
- Verified patient insurance eligibility and entered patient information into system.
- Increased patient confidence in the billing process by providing clear explanations of insurance benefits and coverage limitations.
- Managed sensitive patient information with utmost discretion, adhering to all HIPAA guidelines.
- Mediated disputes between patients and insurance companies, ensuring accurate claim processing and patient satisfaction.
- Educated patients on available financial assistance programs, increasing their access to necessary healthcare services.
- Streamlined insurance verification process, minimizing billing errors and speeding up patient admissions.
- Provided excellent customer service to patients and medical staff.
- Followed document protocols to safeguard confidentiality of patient records.
Auditor/Trainer Coordinator
Regional Medical Center Of Orangeburg & Calhoun Counties
Orangeburg, SC 29118
02.1994 - 02.1996
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
- Ensured compliance with regulatory requirements by performing regular audits and staying up-to-date on industry standards.
- Streamlined audit processes, improving efficiency and reducing time spent on each audit engagement.
- Mentored new hires, resulting in stronger staff development and increased productivity.
- Provided one-on-one mentoring to help individuals reach their full potential within the organization.
- Trained and mentored [Number] new personnel hired to fulfill various roles.
Scheduler
Regional Medical Center Of Orangeburg & Calhoun Counties
Orangeburg, SC
02.1993 - 01.1995
- Coordinated radiology appointments for multiple departments, ensuring optimal resource utilization.
- Worked closely with referring physicians'' offices to coordinate timely referrals for diagnostic imaging services, expediting patient care when necessary.
- Facilitated same-day appointments whenever possible by constantly monitoring available time slots and communicating with clinical staff regarding urgent cases.
- Maintained strict adherence to HIPAA guidelines while handling sensitive patient information during the scheduling process.
- Provided excellent customer service to patients, answering inquiries about radiology procedures and billing processes promptly and accurately.
- Upheld HIPAA regulations and standards for protecting patient information.
- Secured confidential patient information from unauthorized access.
Admitting Interviewer
Regional Medical Center Of Orangeburg & Calhoun Counties
Orangeburg, SC
02.1993 - 01.1994
- Confirmed all insurance benefits met standards of admissions as dictated by policy.
- Assisted in patient admission process based on federal and state laws.
- Collected information, forms and signatures from patients or family members to create efficient admissions experience.
- Verified insurance information, collected payment or co-payment for services and created record of visit for future billing.
- Completed preliminary paperwork for incoming and outgoing patients.
- Obtained payments from patients and scanned identification and insurance cards.
Medical Office Assistant
Santee/St George/North Medical Center
Santee, SC
01.1990 - 01.1993
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Updated patient information and insurance details for accurate electronic medical records.
- Provided prompt, polite and professional in-person and telephone customer service.
- Assisted physicians in providing high-quality care, completing insurance forms and handling referrals promptly.
- Contributed to a positive work environment by maintaining organized files and facilitating clear communication between staff members.
- Assisted medical staff during examinations to enhance patient comfort and safety.
- Facilitated smooth operation of medical office by assisting with billing and insurance verification.
- Managed office logistics by scheduling appointments, maintaining files and collecting payments.
- Assisted physicians with various procedures, improving the quality of care provided to patients throughout their visit.
- Completed EKGs and other tests based on patient presentation in office.
- Recorded and maintained accurate data to facilitate tracking of results.
- Conducted wide range of laboratory tests and recorded results.
Education
Medical Office Assistant/Laboratory
OC Technical College
Orangeburg, SC05-1990
Associate of Science - Secretarial Science
Denmark Technical College
Denmark, SC05-1988
High School Diploma -
ST George High School
St George, SC05-1985
Skills
- Prior authorization process
- Authorizations
- Insurance verification
- Medical terminology knowledge
- Physician order verification
- Patient confidentiality compliance
- ICD-10 coding
- HIPAA compliance
- Benefit coverage
- Insurance procedures
- Data entry
- Precertification requirements
Timeline
Prior Authorization Specialist
MUSC Hospital
03.2023 - Current
Patient Counselor
Regional Medical Center Of Orangeburg & Calhoun Counties
01.1997 - 01.2010
Auditor/Trainer Coordinator
Regional Medical Center Of Orangeburg & Calhoun Counties
02.1994 - 02.1996
Scheduler
Regional Medical Center Of Orangeburg & Calhoun Counties
02.1993 - 01.1995
Admitting Interviewer
Regional Medical Center Of Orangeburg & Calhoun Counties
02.1993 - 01.1994
Medical Office Assistant
Santee/St George/North Medical Center
01.1990 - 01.1993
Medical Office Assistant/Laboratory
OC Technical College
Associate of Science - Secretarial Science
Denmark Technical College
High School Diploma -
ST George High School