Cynthia Nowell
Boerne,Tx
Summary
Versatile professional, Patient-oriented and helpful candidate familiar with 10+ years EPIC experience, Midas, MedSolutions, MS Office and EHR systems coupled with thorough knowledge of medical terminology. Committed to providing personalized service and quality patient care. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Diligent professional with proven track record in navigating complex healthcare systems and ensuring timely approval of medical treatments. Successfully facilitated seamless communication between providers and insurance companies to streamline authorization processes. Demonstrated expertise in medical coding and patient advocacy.
Overview
25
25
years of professional experience
Work History
Prior Authorization Specialist
Firstsource Solutions
Houston, TX
02.2024 - 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.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
Customer Service Specialist
BCforward For Gainwell Technologies
08.2020 - 08.2023
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Resolved customer complaints and addressed emergency requests and needs.
- Responded to customer calls and emails to answer questions about products and services.
- Adhered to company policies and scripts to consistently achieve call-time and quality standards.
- Escalated complicated customer account issues to supervisors and help desk workers.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Documented and detailed calls and complaints using call center's CRM database.
Emergency Room Registration Clerk Patient Access
Sutter Valley Hospital Davis
Davis , California
06.2020 - 08.2020
- Registered high volume of pts into Emergency Dept
- Met with pts bedside to update Medical information into EPIC, including MSPQ, all demographics, insurance information. Collected copays.
- Inpatient notification for insurance
- Performed various administrative tasks by filing, copying and faxing documents.
- Covered phone and emergency systems
- Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
- Obtained payments from patients and scanned identification and insurance cards.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Registered and verified patient records before triage with most up-to-date information.
Radiology Authorization Representative
Sutter Health S3
03.2013 - 11.2019
- Received patient type change notification and took action necessary to meet third-party payer care and coverage guidelines.
- Communicated required insurance information in person and by telephone to patients, physician offices, third party payers and agencies.
- Offered patients and physician offices estimated costs for services documentation.
- Contacted clients about verifying account information and updated services, answered questions and resolved concerns to uphold exceptional customer service standards and promote brand loyalty.
Patient Notification Representative
Sutter Health Central Billing Office
01.2008 - 03.2013
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
- Trained new staff on hospital processes and procedures.
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Provided excellent customer service to patients and medical staff.
- Trained new staff on filing, phone etiquette and other office duties.
Patient Financial Counselor / Advocate
Sutter Health Central Billing Office
04.2005 - 02.2008
- Worked with patients to identify their specific issues and potential support options
- Including necessary paperwork for medi-cal programs Worked on patients income qualifications in order to qualify for all Sutters Financial Assistance programs
- Full , partial, and catastrophic
CNA / Medication Assistant
The Chateau At Rivers Edge Assisted care
02.2000 - 07.2005
- Met with approximately 35 residents daily, helped them clean up, dress and help get ready for what activity they were interested in on that specific day
- Gave medications and filled out the residents personal logs
- Blood pressure, temperature, height, weight and blood sugar
- Assisted resident back up after breakfast, lunch and dinner
- Noted ADL's in log Administered , and counted narcotics and locked in medication cabinet.
Education
GED -
Breckenhiem Public
05-1980
Skills
- Policies and Guidelines
- Payment Scheduling and Collection
- EHR Software
- Registration Coordination
- Insurance Authorizations
- Online Systems
- Electronic Health Records Systems
- Maintaining Privacy
- Insurance Information Collection
- Registration Requirements
- Epic Software
- Service Standard Compliance
- Call Center Operations
- Customer Service
- Critical Thinking
- POS Systems Expertise
- Interpretation and Translation Services
- Professional Telephone Demeanor
- Patient Health Information Access
- Customer Relations
- Documentation
- Conflict Mediation
- Medical Terminology
- Policy and Procedure Adherence
- CRM Software
- Prior authorization process
- Medical appeals handling
- Authorizations
- Insurance verification
- Effective communication skills
- 20 years working with Government/ county payor plans
- 17 years with Commercial plans
Timeline
Prior Authorization Specialist
Firstsource Solutions
02.2024 - Current
Customer Service Specialist
BCforward For Gainwell Technologies
08.2020 - 08.2023
Emergency Room Registration Clerk Patient Access
Sutter Valley Hospital Davis
06.2020 - 08.2020
Radiology Authorization Representative
Sutter Health S3
03.2013 - 11.2019
Patient Notification Representative
Sutter Health Central Billing Office
01.2008 - 03.2013
Patient Financial Counselor / Advocate
Sutter Health Central Billing Office
04.2005 - 02.2008
CNA / Medication Assistant
The Chateau At Rivers Edge Assisted care
02.2000 - 07.2005
GED -
Breckenhiem Public
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