Coral Coutchie

As a Prior Authorization manager, I possess knowledge of PA and medical policy requirements from all insurance plans. I use the guidelines to create training tools for medical staff, including physicians and mid-level providers. These training aids include, but are not limited to, easy-to-follow templates built into the EMR, printable job aids for nursing pods, as well as live assistance via Teams throughout the workday.

Key Responsibilities:

• Serve as a working manager, obtaining outpatient pain management PA with my employees, but also as a subject matter expert on authorization and medical policy criteria.
• Ensure compliance is being met via provider documentation and audits.
• Working directly with the Revenue Cycle Analysts to rectify back-end denials for resubmission.
• Create training aids for submitting and following up on authorization requests via online portals. (Priority Healthy, Availity, EviCore, Cohere, Carelon, etc.)
• Creating training aids for the EMR system, telephone program, and voicemail reconciliation.
• Develop workflows to improve efficiency and maintain accuracy.
• All HR responsibilities for my direct team—recruitment, orientation, training, timecard processing, PTO, and sick time tracking.
• Coordinated cross-department meetings to provide updates on medical policies and workflow process changes.
• Research denials, submit appeals, and work directly with insurance companies in hopes of overturning unfavorable decisions.
• Track authorizations and billing trends to provide physicians insight on any rising issues. Resolved any issues identified in a proactive manner.
• Successfully de-escalate conflict.

As a Prior Authorization and Scheduling Manager, I provided support to a team of 20+ employees. I oversaw all processes related to obtaining prior authorizations for outpatient procedures, advanced imaging, specialty procedures, physical therapy, and scheduling all patients. I served as a working manager and worked alongside my team day-to-day, working on providers' schedules.

• Created processes and workflows with the director and assistant director of operations.
• Worked closely with the RCM team to ensure that denials were rectified in a timely fashion.
• Monitored scheduling and referral trends via reports and contacted referring offices to provide support with the Senior Marketing Analyst.
• Created training aids for all new employees for all systems, including the EMR system, telephone and voicemail software, and the timeclock/PTO website.
• All HR tasks, including phone screens, interviews, ordering UDS, background checks, and new hire paperwork.
• Notified physicians after identifying documentation errors and billing trends.
• Served as the subject matter expert on medical policies for all insurance payers.
• Regularly attended practice meetings to explain process changes in depth and train physicians on medical policy guidelines.

As a front office manager, I was in charge of all front office staff, responsible for scheduling, authorizations for procedures, and referrals. I performed the duties of a working manager alongside my team, scheduling surgeries.

• Direct contact for all pharmaceutical representatives.
• Conducted weekly or bi-weekly staff meetings.
• Hiring, training, and quarterly reviews of all employees.
• Developing, reviewing, and implementing processes and workflows for front desk receptionists.
• Inventory and ordering of office supplies and reloading the postage machine.
• Exercised strong decision-making and problem-solving skills with patient insurance issues.
• Scheduled specialty procedures for in-office occupational therapists.
• Ensure staff is up to date on education requirements for OSHA and HIPAA.
• Worked closely with surgery centers and hospitals to ensure block times were correct, anesthesia was available, and operations ran smoothly.
• All other management related tasks assigned by director.