Cynitha Hillard

• Review provider orders and documentation to determine if prior authorization is required.
• Verify insurance eligibility and benefits as part of the authorization process.
• Submit prior authorization requests to payers via portals, fax, or phone.
• Track status and follow up on pending authorizations.
• Communicate with providers and departments about prior authorization status.
• Collaborate with clinical staff to obtain additional documentation when needed.
• Maintain up-to-date knowledge of payer policies and authorization guidelines.
• Escalate denials or complex cases to appropriate clinical or supervisory staff.
• Participate in audits, quality improvement initiatives, and team meetings.
• Trained new team members on protocols and systems for prior authorization workflows.
• Implemented process improvements that reduced turnaround times for authorizations.

• Maintained up-to-date knowledge of insurance eligibility, payer policies, and regulations.
• Processed initial and ongoing authorization requests in EPIC/Olive Pathway systems.
• Determined third-party payers and verified coverage and prior authorization requirements.
• Improved revenue cycle efficiency by streamlining processes and implementing best practices.
• Ensured compliance with HIPAA regulations and organizational policies.

• requests and ensuring timely responses.

• Streamlined workflow for faster approval turnaround times, handling high volume of insurance verification tasks.

• Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.

• Increased accuracy of insurance coverage validation by utilizing available tools and resources to verify eligibility requirements quickly.

• Delivered consistent high-quality work under pressure, effectively managing high caseloads while meeting deadlines set forth by payers or internal guidelines.

• Provides support to clinical team in order to facilitate administrative components of clinical referrals for various AIM services

• Reviews referrals for completeness and follows up for additional information if necessary

• Developed strong relationships with external healthcare facilities, fostering collaborative approach to patient care coordination.

• Verifies insurance coverage and completes pre-authorization process for radiology and other imaging exams (CT, MRI, MRA, PET, et.) following established process and procedures

Enhanced patient satisfaction by promptly addressing inquiries and resolving issues related to clinical referrals

• Assist large call volume of customers every day with positive attitude and focus on customer satisfaction.

• Process Verification and New Enrollment applications

• Promptly responded to inquiries, requests from prospective customers, scheduled appointments for benefits advisors and other assigned duties.

• Maintained a high level of product knowledge, providing accurate information to customers in regard to Health Reimbursement Accounts, Medicare supplement and prescription drug coverage.