Lindonna Reed
Detroit,MI
Summary
Authorization Specialist with over 15 years of experience seeking to utilize and expand my skills, and also support, promote, maintain and restore health to those we serve. Proven ability to build positive relationships and communicate effectively with physicians, medical professionals, patients and family members. Brings proven track record of success in determining eligibility and resolving complex cases.
Overview
9
9
years of professional experience
Work History
Authorization Coordinator
Detroit Medical Center- Detroit Receiving Hospital
11.2023 - Current
- Knowledge of procedure authorization and its direct impact on the hospital's revenue cycle
- Responsible for obtaining prior authorizations for all surgical and procedural orders by successfully completing the the authorization pieces with all insurance companies
- Review chart documentation to ensure patient meets medical policy guidelines and prioritize incoming authorization request according to urgency
- Obtain authorization via payer website or by phone and follow up on pending cases
- Initiate appeals for denied authorizations and respond to clinic questions regarding payer medical policy guidelines
- Confirm accuracy of cpt code and icd-10 on the procedure orders
- Request retro authorizations according to the guidelines of the insurance companies
- Perform all duties required to prepare, adjudicate and or resolve all claim types according to plan, contact and insurance information
- Knowledge in resolving denials
- Unbilled claims and other claim issues
- Knowledge of medical
- Professional and facility claims for processing and payment as well as diverse insurance background.
- Trained staff on current eligibility requirements and policies.
Authorization Specialist/Revenue Cycle Specialist
Straith Hospital for Special Surgery
12.2021 - 10.2023
- Knowledge of procedure authorization and its direct impact on the hospital's revenue cycle
- Responsible for obtaining prior authorizations for all surgical and procedural orders by successfully completing the the authorization pieces with all insurance companies
- Review chart documentation to ensure patient meets medical policy guidelines and prioritize incoming authorization request according to urgency
- Obtain authorization via payer website or by phone and follow up on pending cases
- Initiate appeals for denied authorizations and respond to clinic questions regarding payer medical policy guidelines
- Confirm accuracy of cpt code and icd-10 on the procedure orders
- Request retro authorizations according to the guidelines of the insurance companies
- Perform all duties required to prepare, adjudicate and or resolve all claim types according to plan, contact and insurance information
- Knowledge in resolving denials
- Unbilled claims and other claim issues
- Knowledge of medical
- Professional and facility claims for processing and payment as well as diverse insurance background.
- Trained staff on current eligibility requirements and policies.
Surgical Scheduler Coordinator
DMC Urology Reconstruction Clinic
11.2017 - 12.2021
- Scheduled surgical cases with physicians' based on priority and medical emergency basis
- Coordinates with surgical representatives and arrange for all necessary equipment and instruments to be present during the time of surgery
- Worked closely with insurance companies utilization management teams to ensure procedures were covered
- Obtained prior authorizations for surgical procedures
- Scheduled pre-operative visits, procedures, and post-operative follow-up appointments in EMR system
- Improved clinical operations by coordinating with team clinicians
- Coordinated with other practitioners on behalf of patients to transfer paperwork, set up tests, and arrange specialist referrals.
Medical Office Assistant
DMC Urology Reconstruction Clinic
07.2016 - 11.2017
- Performed tasks including maintaining files, verifying insurance claims on behalf of patients, and scanning documents
- Recognized on multiple occasions for efficiently handling administrative duties, including answering phones, scheduling appointments, maintaining medical records, processing patients, billing, and bookkeeping
- Resolved incoming calls concerning members eligibility, benefits, provider information, monthly premium billing, clinical, and pharmacy needs.
Education
High school diploma - College Prep
Northern High School
Detroit, MICertificate - Medical Assistant
Detroit Business Institute
Southfield, MISkills
- Experienced with Athena EMR
- CPT/ ICD-10 coding
- Experienced with Champs, Web
- Denis, C-snap, WPS Medicare, Availity, etc
- Schedule coordination
- Clinical support
- Insurance verification
- Medical terminology
- HIPAA compliance
- Medical Office Experience
- Medical Records
- Utilization Management
- Microsoft Office
- Medical Billing
- Authorizations Understanding
- Administrative Management
- Document Processing
- Applicant Engagement
- Effective Communication Skills
- Software Expertise
- Bls/Cpr Certified
Work Type
Full TimePart TimeWork Location
RemoteOn-SiteHybridTimeline
Authorization Coordinator
Detroit Medical Center- Detroit Receiving Hospital
11.2023 - Current
Authorization Specialist/Revenue Cycle Specialist
Straith Hospital for Special Surgery
12.2021 - 10.2023
Surgical Scheduler Coordinator
DMC Urology Reconstruction Clinic
11.2017 - 12.2021
Medical Office Assistant
DMC Urology Reconstruction Clinic
07.2016 - 11.2017
High school diploma - College Prep
Northern High School
Certificate - Medical Assistant
Detroit Business Institute
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