Cathy Ristow
Rockledge,FL
Summary
Detail-oriented and results-driven healthcare operations professional with 18+ years of experience in claims processing, prior authorizations, and cross-functional collaboration. Proven track record of improving workflow efficiency, reducing claim denials, and leading process improvements. Adept at navigating complex systems, training teams, and delivering high-quality service in fast-paced environments.
Overview
8
8
years of professional experience
Work History
Prior Authorization / Claims Specialist
A3I Health Inc.
Lake Mary, FL
09.2020 - Current
- Spearheaded end-to-end claims and authorization processes, reducing denials by 25% through proactive audits and payer compliance checks.
- Collaborated with internal departments and external partners to resolve discrepancies, ensuring 98% accuracy in claims submissions.
- Conducted in-depth audits of CPT codes, demographics, and authorization data, significantly improving first-pass claim acceptance rates.
- Designed and implemented a claims tracking report that improved follow-up efficiency and reduced processing delays by 30%.
- Led team training sessions on policy updates and best practices, enhancing team consistency and performance.
- Developed performance dashboards to monitor productivity and quality, driving continuous improvement.
Insurance / Claims Specialist
Florida Autism Center
Lake Mary, FL
01.2018 - 09.2020
- Verified Advanced behavior therapy authorizations across multiple states, ensuring compliance with payer guidelines and reducing claim rejections.
- Partnered with clinicians to align treatment plans and coding with insurance requirements, improving billing accuracy.
- Resolved complex denials and appeals, recovering over $80,000 in pending claims through strategic reporting and follow-up.
- Maintained meticulous documentation of claim statuses and payer communications, streamlining issue resolution.
- Identified and corrected ICD-10 coding discrepancies, contributing to a 20% increase in successful reimbursements.
Education
Management and Leadership Training -
Coursera
Online 08.2023 - 01.2024
HIPAA Certification - Health Administration
Online Certification
Lake Mary, FL 01.2024 - 01/2024
Customer One Training - Health Administration
Online
Lake Mary , FL 01.2022 - 01/2022
Health Administration
Coursera
Online 01.2023 -
Skills
- Claims and authorization management
- Process improvement and workflow optimization
- Insurance verification and appeals
- Cross-functional collaboration
- Data analysis and reporting
- Training and team leadership
- Documentation and compliance
- Microsoft Excel
- EMR/claims systems
Additional Highlights
- Thrive in high-pressure, deadline-driven environments
- Strong organizational and time-management skills
- Committed to continuous learning and professional growth
Timeline
HIPAA Certification - Health Administration
Online Certification
01.2024 - 01/2024
Management and Leadership Training -
Coursera
08.2023 - 01.2024
Health Administration
Coursera
01.2023 -
Customer One Training - Health Administration
Online
01.2022 - 01/2022
Prior Authorization / Claims Specialist
A3I Health Inc.
09.2020 - Current
Insurance / Claims Specialist
Florida Autism Center
01.2018 - 09.2020