Cortnie Defa
West Jordan,UT
Summary
Hardworking Prior Authorization Specialist and customer service with High Value status. With successful background working closely with insurance company representatives to gain pre approval for procedures and testing. Also background in card member services working with billing and fraud. Detail-oriented performer with over 10 years of managing medical documentation. Considered team player with exemplary multitasking skills. I have been a stay at home mom the last few years and now that my kids will be in school I am ready to get back out there and start working again.
Overview
14
14
years of professional experience
Work History
Insurance Authorization and Surgery Authorization
Heiden Orthopedics
Cottonwood Heights, UT
08.2010 - 04.2019
- Reviewed appeals for prior authorization requests and communicated with both patient and insurance.
- Worked with insurance company to get prior authorization for imaging and surgery procedures.
- Processed patients lacking coverage for planned procedures.
- Made contact with insurance carriers to discuss policies and individual policies.
- Verified client information by analyzing existing evidence on file.
- Called hospital and imaging facilities to schedule procedures for patients.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Generated, posted and attached information to claim files.
- Collected patient balances and copays.
- Scheduling for follow up appointments.
- Removed stitches and staples on surgical patients.
- Casting and fitted for braces for fracture patients.
- Pulled medical records for all upcoming patients.
Medical Assistant and Receptionist
Utah Sleep Specialists
West Jordan, UT
06.2006 - 07.2010
- Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability.
- Notified manager of incidents and potential incidents relating to patients and staff for swift action.
- Invoiced patients accurately in line with charging guidelines.
- Supported office staff and operational requirements with administrative tasks.
- Organized and maintained patient chart filing system to promote quick data finding for staff.
- Received and routed laboratory results to correct clinical staff members.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Conducted patient intake interviews, recording and documenting relevant information.
- Placed new supply orders, managed inventory and restocked clerical spaces.
- Registered and verified patient records before triage with most up-to-date information.
- Completed administrative patient intakes with case histories and insurance information.
- Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
- Processed medical insurance claims and payments.
- Weighing, measuring, and taking health history for pediatric patients.
- Scheduled patients for surgical procedures and sleep studies.
- Collected payments for patients balances and copays.
- PFT (Pulmonary Function test) tech.
High Value Customer Service
American Express
West Valley City, Utah
08.2005 - 06.2006
- Inbound calls on high value customer cards.
- Took payments and explained billing to card members.
- Set up fraud cases with card member and asked appropriate questions to get fraud cases started.
- Submitted fraud cases to fraud department.
- Processed requests for Line of credit increases.
Education
High School Diploma -
Highlands Ranch High School
Highlands Ranch, CO06.2003
Skills
- Patient Referral
- Reminder Calls
- Referral Tracking
- Office Supplies and Inventory
- Outpatient Procedure scheduling
- Fraud disputes
- PFT machine tech
- Information Assistance
- Call Transfers
- Insurance Authorizations
- Understanding of Insurance Details
- Demographics Information
- Greeting Visitors
- Insurance Information Oversight
- Authorization Verification
- Benefit Coverage
- Medical Terminology
- Data Entry
- Patient Scheduling
- Patient Identification
- Professional Relationships
- Electronic Health Records Systems
- Records Maintenance
- Prior Authorization Processing
Education
Highlands Ranch, CO
Skills
- Insurance Plan Verification
- Pulmonary Function Testing
- Customer Interaction
- Reviewing Medical Histories
- Payment Collection
- Medical Information Collection
- Policy and Procedure Explanations
- Great Mathematical Skills
- Authorizations
- Recordkeeping
Contact
West Jordan, UT 84081
Timeline
Insurance Authorization and Surgery Authorization
Heiden Orthopedics
08.2010 - 04.2019
Medical Assistant and Receptionist
Utah Sleep Specialists
06.2006 - 07.2010
High Value Customer Service
American Express
08.2005 - 06.2006
High School Diploma -
Highlands Ranch High School