Cheryl Chockey
Shelton,CT
Summary
Healthcare professional prepared for role with strong background in managing prior authorizations and fostering positive relationships with healthcare providers and insurance companies. Known for collaborative approach and consistently achieving results despite changing needs. Proficient in medical coding, insurance guidelines, and effective communication.
Overview
10
10
years of professional experience
Work History
Prior Authorization Specialist
Aspira Women’s Health
01.2019 - 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.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- 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.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- 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.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
- Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
Accounts Receivable Coordinator
Cooper Surgical
08.2017 - 01.2019
- Supported month-end closing procedures by reconciling accounts receivable ledgers and preparing aging reports for management review.
- Improved invoice accuracy by thoroughly reviewing billing data before issuing final statements.
- Expedited payment collection with timely submission of invoices and proactive communication with clients.
- Strengthened relationships with key clients by providing exceptional service in addressing inquiries regarding account balances or payment issues.
- Partnered with cross-functional departments to resolve discrepancies in customer accounts, promoting a cohesive work environment.
- Reduced outstanding debts through consistent follow-up on overdue invoices and negotiating payment plans.
- Maintained accurate records of financial transactions, ensuring compliance with company policies and industry regulations.
- Collaborated with sales teams to address customer disputes, resulting in prompt resolution and maintained relationships.
- Posted customer payments by recording cash, checks, and credit card transactions.
- Verified discrepancies and resolved clients' billing issues
- Prepared bills receivable, invoices, and bank deposits.
- Processed incoming payments in accordance with established financial policies.
- Reconciled daily AR ledger and verified proper posting.
- Optimized organizational systems for payment collections, AP/AR, deposits, and recordkeeping.
- Provided backup to front desk to step in to assist with various tasks whenever employee was absent or at lunch.
Patient Financial Services Representative
Orthopedic Speciality Group
04.2016 - 08.2017
- Maintained compliance with industry regulations, ensuring proper handling of sensitive patient data during the billing process.
- Improved patient satisfaction by providing timely and accurate financial information.
- Negotiated payment arrangements with self-pay patients, offering flexible solutions that aligned with their financial capabilities.
- Streamlined billing processes for increased efficiency and accuracy in payment collections.
- Promoted a positive patient experience, addressing concerns and resolving issues related to billing or insurance coverage.
- Coordinated closely with clinical teams to verify services rendered, ensuring accurate billing and reimbursement for all provided care.
- Assisted patients in understanding their financial responsibilities, guiding them through available payment options and resources.
- Improved patient trust and confidence, resolving financial disputes and negotiating payment plans tailored to individual needs.
- Completed data entry tasks with accuracy and efficiency.
- Followed established procedures to enter and process data correctly.
- Organized, sorted, and checked input data against original documents.
- Scanned documents and saved in database to keep records of essential organizational information.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Provided guidance to registration staff regarding accurate collection of demographic information from patients upon admission.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Improved communication between medical staff and patients by explaining insurance benefits and financial responsibilities.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Enhanced claim processing efficiency by verifying insurance coverage and obtaining pre-authorizations for procedures.
Patient Financial Counselor
Orthopedic Speciality Group
10.2014 - 04.2016
- Increased patient confidence in the billing process by providing clear explanations of insurance benefits and coverage limitations.
- Negotiated payment plans with patients, maintaining a high rate of successful payments.
- Enhanced patient satisfaction by effectively explaining financial options and answering billing inquiries.
- Developed strong relationships with insurance providers, facilitating prompt resolution of claim issues and disputes.
- Developed customized payment solutions based on individual patient needs, promoting long-term account sustainability.
- Maintained up-to-date knowledge on evolving healthcare regulations, sharing insights with colleagues for continuous improvement.
- Trained new staff on patient financial services best practices, elevating overall performance of financial counseling team.
- Educated patients on available financial assistance programs, guiding them through application processes when needed.
- Streamlined insurance verification process, minimizing billing errors and speeding up patient admissions.
- Streamlined communication between financial counseling department and clinical staff, ensuring unified approach to patient care.
- Ensured compliance with HIPAA regulations throughout all aspects of the patient account collection process.
- Reduced outstanding balances by identifying and resolving discrepancies in patient accounts.
- Utilized advanced software tools to track overdue payments and update account information accurately.
- Negotiated payment plans with patients, ensuring timely payments and improved overall collection rates.
- Collaborated with insurance companies to ensure proper reimbursement for services rendered.
Education
High School Diploma - General Studies
Fairfield High School
Fairfield, CT06.1990
Skills
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Insurance verification
- Effective communication skills
- Data entry
- Professionalism and ethics
- Billing procedures
- Retro-authorizations
- Patient confidentiality compliance
- Records maintenance
- Patient scheduling
- Claims processing experience
- Claim research
- Utilization review experience
- HIPAA compliance
- Knowledgeable in xifin, centricity, sales force
Timeline
Prior Authorization Specialist
Aspira Women’s Health
01.2019 - Current
Accounts Receivable Coordinator
Cooper Surgical
08.2017 - 01.2019
Patient Financial Services Representative
Orthopedic Speciality Group
04.2016 - 08.2017
Patient Financial Counselor
Orthopedic Speciality Group
10.2014 - 04.2016
High School Diploma - General Studies
Fairfield High School
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