Deborah kline
Retinal and Ophthalmic Consultants
Somers Point,NJ
23
years of professional experience
Results-driven Authorization Specialist with a strong background in medical terminology and claims management. Proven ability to ensure HIPAA compliance and streamline insurance verification processes.
Work History
Authorization Specialist
12 Years 9 Months- Processed patient authorization requests efficiently, ensuring compliance with insurance guidelines.
- Reviewed and verified medical documentation to support authorization approvals.
- Coordinated communication between patients, healthcare providers, and insurance companies for seamless service delivery.
- Maintained accurate records of authorization statuses and follow-up actions in electronic systems.
- Facilitated authorization requests by reviewing clinical documentation for compliance with insurance guidelines.
- Trained new staff on procedures and best practices in prior authorization workflows and documentation standards.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Medical Claims Processor
12 Years 9 Months- Processed claims for our Glaucoma specialist in the practice with high accuracy, ensuring compliance with regulatory standards.
- Reviewed and adjudicated insurance claims for ophthalmic services, improving turnaround times.
- Collaborated with healthcare providers to resolve discrepancies in claim submissions.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Customer Service Representative
9 Years 10 Months- Resolved customer inquiries and issues through effective communication and problem-solving techniques.
- Ensured product availability by managing inventory levels and coordinating with suppliers.
- Processed orders accurately, enhancing customer satisfaction and operational efficiency.
- Mentored new staff in best practices for customer service interactions and system usage.
Education
High School Diploma
Skills
Medical terminology expertise
Claims management
Insurance verification
Data entry proficiency
HIPAA compliance
Effective communication skills
Knowledgeable in Next Gen Ophthalmic software
Proficiency in Genentech Ophthalmic software
Proficiency in SamaCare authorization program
Timeline
Authorization Specialist
Retinal and Ophthalmic Consultants
09.2013 - 06.2026Read More
Medical Claims Processor
Retinal and Ophthalmic Consultants
09.2013 - 06.2026Read More
Customer Service Representative
City Supply Company
04.2003 - 02.2013Read More
Mainland Regional Highschool
High School Diploma
Read More