Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures, medications and testing. Detail-oriented performer with over 25 years of managing documentation. Considered team player with exemplary multitasking skills.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist (RMA)
Emory Heart And Vascular Center
08.1998 - Current
Streamlined prior authorization processes by implementing efficient tracking systems.
Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.
Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
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.
Assisted in development of departmental guidelines and procedures for prior authorization processes, improving overall efficiency.
Provided training to new staff members on intricacies of various insurance plans and their specific prior authorization requirements.
Contributed to high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
Managed high volume 25 + incoming calls, maintaining professionalism while effectively addressing needs of callers seeking assistance with prior authorizations.
Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
Participated in cross-functional initiatives to improve overall efficiency and effectiveness of prior authorization process for all involved parties.
Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
Analyzed medical records and other documents to determine approval of requests for authorization.
Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
Responded to inquiries from healthcare providers regarding prior authorization requests.
Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Researched denied claims and contacted insurance companies to resolve these issues.
Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
Developed and maintained productive working relationships with healthcare providers.
Fielded telephone inquiries on authorization details from plan members and medical staff.
Assisted clients with completion of applications and paperwork.
Reviewed applications for different aid programs and determined which qualification criteria for individuals.
Communicated with people from various cultures and backgrounds on application process.
Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
Registered Medical Assistant
Emory Heart And Vascular Center
08.1998 - Current
Sanitized, restocked, and organized exam rooms and medical equipment.
Maintained strict confidentiality while handling sensitive patient information in accordance with HIPAA guidelines.
Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
Completed thorough chart reviews to ensure proper documentation of all pertinent medical information.
Called and faxed pharmacies to submit prescriptions and refills.
Documented vital signs and health history for over 25-30 patients in clinic daily.
Prepared examination rooms with necessary tools and instruments prior to each appointment, enabling smooth transitions between patients.
Contributed to successful health outcomes by effectively communicating between patients and providers about treatments, medications, or follow-up instructions.
Collected and documented patient medical information such as blood pressure and weight.
Taught patients about medications, procedures, and care plan instructions.
Improved patient experience by promptly greeting, preparing, and escorting individuals through their visits.
Supported diagnostic processes with proficient collection of specimen samples for laboratory testing purposes.
Performed essential administrative tasks such as scheduling appointments, updating records, and coordinating referrals.
Collaborated with healthcare team to create personalized care plans for patients.
Enhanced patient care by efficiently performing routine tests and measurements.
Increased efficiency in workplace by organizing and maintaining a clean and functional work environment.
Aided in prevention of illnesses by administering vaccinations according to established protocols.
Strengthened patient-provider relationships through compassionate communication and attentive listening skills.
Provided comprehensive support for patients during their appointments, addressing concerns and answering questions.
Reduced wait times for patients by swiftly triaging incoming cases based on urgency or severity of symptoms.
Managed inventory of medical supplies and equipment to maintain optimal clinic operations.
Assisted with routine checks and diagnostic testing by collecting and processing specimens.
Enhanced patient outcomes by providing knowledgeable education on procedures, medications, and other physician instructions.
Promoted office efficiency, coordinating charts, completing insurance forms, and helping patients with diverse needs.
Continuously improved professional knowledge through attendance at workshops, seminars, or conferences related to field of medical assisting.
Obtained client medical history, medication information, symptoms, and allergies.
Performed medical records management, including filing, organizing and scanning documents.
Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed.
Verified patient insurance coverage and collected required co-payments.
Obtained and documented patient medical history, vital signs and current complaints at intake.
Completed EKGs and other tests based on patient presentation in office.
Answered telephone calls to offer office information, answer questions, and direct calls to staff.
Oriented and trained new staff on proper procedures and policies.
Prepared lab specimens for diagnostic evaluation.
Measured patient pulse oximetry.
Explained procedures to patients to reduce anxieties and increase patient cooperation.
Updated inventory, expiration and vaccine logs to maintain current tracking documentation.
Helped improve patient outcomes by educating and advising on relevant treatments and care.
Procedure Scheduler
Emory Heart And Vascular Center
08.1998 - Current
Improved office workflow by collaborating with colleagues on best practices for scheduling processes.
Coordinated with medical professionals to ensure seamless communication regarding patient appointments and procedures.
Developed an organized filing system to facilitate easy access to important documents and records pertaining to scheduled procedures.
Maintained up-to-date knowledge of insurance requirements, enabling smooth billing processes and avoiding delays in payment collection.
Contributed to revenue growth by efficiently filling procedure slots, minimizing cancellations, and reducing no-shows.
Enhanced patient scheduling efficiency by streamlining appointment booking procedures.
Reduced wait times for patients by optimizing the scheduling process and eliminating doublebookings.
Assisted in reducing patient anxiety by providing clear communication about upcoming procedures, including necessary preparations and post-procedure care instructions.
Managed high call volumes while maintaining exceptional customer service standards for patients and staff members.
Provided consistent support to physicians by managing their schedules, ensuring availability for necessary procedures, and prioritizing urgent cases when needed.
Assisted in improving overall patient satisfaction through timely and accurate schedule management.
Facilitated a positive work environment by addressing concerns promptly and fostering open communication among team members about scheduling issues or challenges.
Enhanced team collaboration by sharing knowledge of the latest industry trends in procedure scheduling techniques.
Demonstrated flexibility in adapting to changing priorities while maintaining excellent attention to detail in processing complex schedules.
Coordinated with other departments to facilitate seamless operation and excellent patient care.
Followed up with patients to reschedule missed appointments.
Answered telephone calls to offer office information, answer questions, and direct calls to staff.
Maintained confidentiality of patient information to comply with HIPAA regulations and protect patient privacy.
Managed multiple schedules and prioritized tasks to meet demands of fast-paced work environment.
Verified insurance coverage and eligibility for medical services prior to scheduling appointments to prevent billing issues.
Confirmed appointments one day prior to minimize missed appointments and maximize clinic utilization.
Answered phone calls and messages for 13-physician Cardiology medical facility, scheduling appointments, and handling patient inquiries.
Managed complex calendars for multiple medical practitioners, verifying accuracy of all appointments.
Performed various administrative tasks by filing, copying and faxing documents.
Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
Obtained payments from patients and scanned identification and insurance cards.
Prepared and processed patient referrals and transfer requests.
Organized and maintained patient chart filing system to promote quick data finding for staff.
Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
Phlebotomist
Emory Heart And Vascular Center
08.1998 - Current
Enhanced patient experience through compassionate care and communication during blood draw procedures.
Labeled transfer tubes and followed exact directions for handling and storing specimens for transport.
Maintained high level of accuracy in labeling and tracking specimens, ensuring proper testing and timely results.
Centrifuged blood samples as outlined in clinical protocols.
Completed proper sanitation and cleaning of equipment and work areas between patients.
Excelled in high-pressure situations, maintaining composure and professionalism during peak hours and emergency scenarios.
Reduced contamination risks by strictly adhering to infection control protocols and maintaining clean work environment.
Stocked phlebotomy cart or carrier with appropriate supplies.
Tracked collected specimens by initialing, dating, and noting times of collection.
Established and maintained positive working relationships with patients, staff and clinical personnel to build trust and camaraderie.
Improved patient comfort by efficiently drawing blood samples using various techniques such as venipuncture and capillary puncture.
Assembled tourniquets, needles, and blood collection devices to prepare work trays.
Packaged and shipped specimens to central lab daily.
Used personal protective equipment correctly to protect coworkers and patients.
Increased patient satisfaction rates through consistent delivery of professional phlebotomy services tailored to individual needs.
Collaborated with medical professionals to ensure accurate test orders and appropriate sample collection methods were used.
Reviewed patient records for accuracy and completeness.
Organized daily work based on collection priority.
Addressed questions and concerns to educate patients on collection process and procedures.
Ensured uninterrupted service by properly maintaining phlebotomy equipment, including centrifuges, needles, and tourniquets.
Actively engaged with patients to educate them on proper post-draw care, reducing potential complications and ensuring their comfort throughout process.
Contributed to reduction in wait times by quickly assessing patient needs, prioritizing cases based on urgency, and efficiently completing blood draw procedures.
Participated in cross-training initiatives, bolstering overall skill set of team and promoting collaborative work environment.
Participated in continuing education programs to stay up to date on new technologies and procedures.
Provided support to laboratory staff, facilitating prompt analysis of collected samples for expedited results delivery.
Played integral role in managing inventory levels within department, ordering necessary supplies while minimizing waste to maintain cost-effective operations.
Collected blood samples in accordance with laboratory protocols and regulations.
Collected blood samples using vacutainer tubes, tourniquets, syringes, butterfly needles, and straight needles.
Adhered to HIPAA standards and maintained patient confidentiality in all interactions.
Verified patients' identification for proper sample collection.
Drew blood from veins by vacuum tube, syringe, or butterfly venipuncture methods.
Verified proper storage and transportation of specimens to laboratories.
Protected patients by following infection control, sharps disposal, and biohazardous waste disposal procedures.
Spoke with patient to gather information for lab records, reduce fear, or anxiety and optimize cooperation.
Followed established safety protocols and standards to minimize risk of infection and injury.
Assisted in training and onboarding new phlebotomists.
Monitored supply levels and placed orders for laboratory supplies.
In House Procedure Tech
Emory Heart And Vascular Center
08.1998 - Current
Self-motivated, with strong sense of personal responsibility.
Worked effectively in fast-paced environments.
Skilled at working independently and collaboratively in team environment.
Proven ability to learn quickly and adapt to new situations.
Excellent communication skills, both verbal and written.
Worked well in team setting, providing support and guidance.
Demonstrated respect, friendliness and willingness to help wherever needed.
Assisted with day-to-day operations, working efficiently and productively with all team members.
Managed time efficiently in order to complete all tasks within deadlines.
Organized and detail-oriented with strong work ethic.
Paid attention to detail while completing assignments.
Used critical thinking to break down problems, evaluate solutions and make decisions.
Strengthened communication skills through regular interactions with others.
Adaptable and proficient in learning new concepts quickly and efficiently.
Learned and adapted quickly to new technology and software applications.
Developed and maintained courteous and effective working relationships.
Demonstrated strong organizational and time management skills while managing multiple projects.
Education
Registered Medical Assistant - Medical Assistant Front And Back Office
APRN Advanced Practice Registered Nurse at Premier Heart and Vascular CenterAPRN Advanced Practice Registered Nurse at Premier Heart and Vascular Center