CATONA WEBB
Nashville,TN
Summary
Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 10years of managing documentation. Considered team player with exemplary multitasking skills.
Overview
10
10
years of professional experience
Work History
Prior Authorization Specialist
Centene
12.2023 - Current
- Reviewed revenue codes, CPT/HCPCS codes, diagnosis codes, and procedure information to ensure services were accurately represented on authorization requests.
- Verified revenue codes against payer requirements and patient benefits to determine whether services required prior authorization or additional review.
- Worked with facility and professional billing information, including revenue codes, procedure codes, modifiers, and units of service, to support accurate authorization processing.
- Reviewed authorization requests for discrepancies between revenue codes, services requested, clinical documentation, and payer guidelines.
- Researched payer-specific requirements related to revenue codes and identified missing or incorrect coding information that could result in authorization delays, claim denials, or payment issues.
- Collaborated with billing, coding, clinical, and provider teams to resolve revenue code and authorization discrepancies before services were rendered or claims were submitted.
- Utilized knowledge of UB-04/CMS-1450 billing concepts and revenue codes when reviewing facility-based services and authorization requests.
Authorization Specialist Supervisor
SmileDirectClub
08.2016 - 11.2023
- Reviewed prior authorization requests for medical necessity, eligibility, and payer requirements.
- Coordinated with providers, payers, and patients to resolve authorization delays and missing documentation.
- Trained staff on benefits procedures, system workflows, and policy interpretation.
- Audited benefits records to maintain compliance with company policies and regulatory requirements.
- Assisted with appeals and reconsideration by gathering medical records, clinical documentation, payer correspondence, and other supporting information.
- Verified patient eligibility, benefits, coverage, and authorization requirements using insurance portals, payer systems, and electronic health records.
Education
Diploma - General Studies
Nashville School of the Arts
Nashville, TN05.2012
Skills
- Prior Authorization
- Insurance verification
- Medicaid
- ICD-10
- Prior authorization
- Medical terminology
- Appeals handling
- Regulatory Compliance
- Data Analysis
- Workflow Optimization
- Project Management
- Training Development
- Case Management
- Prior authorization
- Medical coding
- Appeals management
- Microsoft Office
Personal Information
Title: HEALTHCARE OPERATIONS & AUTHORIZATION LEADER
Timeline
Prior Authorization Specialist
Centene
12.2023 - Current
Authorization Specialist Supervisor
SmileDirectClub
08.2016 - 11.2023
Diploma - General Studies
Nashville School of the Arts