Prior Authorizations
Charity Hope Richards
Memorial Hospital of Sweetwater County
Rock Springs,WY
Summary
Results-driven professional with expertise in prior authorizations and insurance verification. Recognized for maintaining regulatory compliance and providing excellent customer service, ready to streamline processes and enhance patient care.
Work History
Prior Authorization Representative
2 Years 11 Months- Collaborated with healthcare providers to gather necessary documentation for authorizations.
- Processed prior authorization requests efficiently to ensure timely patient care.
- Evaluated insurance policies to determine coverage and eligibility requirements accurately.
- Maintained comprehensive records of authorization activities in electronic health systems.
- Monitored compliance with regulatory standards and organizational policies in authorization processes.
- Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
- Verified eligibility and compliance with authorization requirements for service providers.
Clerical Support Associate
5 Years 3 Months- Managed intake processes, accurately collecting and inputting client information into electronic health records systems.
- Coordinated scheduling for client appointments, ensuring efficient use of resources and personnel.
- Developed and maintained filing systems to enhance document retrieval efficiency and compliance with organizational standards.
- Assisted in the preparation of reports and presentations, streamlining communication across departments.
- Responded to inquiries from callers seeking information.
- Provided clerical support to company employees by copying, faxing, and filing documents.
- Facilitated smooth operation of daily tasks through efficient coordination of departmental resources and personnel schedules.
Custodial Worker
1 Year 10 Months- Maintained cleanliness and sanitation standards across campus buildings and facilities.
- Operated cleaning equipment, including floor scrubbers, vacuums, and pressure washers.
- Collaborated with team members to complete daily custodial tasks efficiently.
- Inspected and restocked supplies to ensure availability for ongoing operations.
Residential Team Leader
5 Years- Led residential team in implementing individualized care plans for clients.
- Monitored resident progress and adjusted support strategies as needed.
- Developed and maintained strong relationships with families, ensuring consistent updates on resident well-being.
- Contributed to the development of new programs and services by actively participating in brainstorming sessions, sharing ideas, and providing input based on personal expertise.
- Fostered positive relationships with residents' families through effective communication, addressing concerns promptly, and providing updates on progress.
- Maintained a high level of professionalism within the residential setting by upholding company values, demonstrating ethical conduct, and serving as a role model for other team members.
- Collaborated with therapists and healthcare providers to develop comprehensive treatment plans for residents based on individual needs and goals.
Education
High School Diploma
Skills
HIPAA compliance
Problem-solving
Time management
Reliability
Multitasking
Customer service
Effective communication
Team collaboration
Decision-making
Professionalism
Accomplishments
- Used Microsoft Excel to develop tracking spreadsheets for authorizations and data for insurances.
- Documented and resolved Retrospective authorizations which led to getting authorization and payment for the hospital.
- Overcame lack of training and found understanding in what was needed in my role as prior authorization representative.
- Maintained clean, clear records for hospital billers.