Delilah Armstrong
Elkhart,Indiana
Summary
Detail-oriented Precertification Specialist skilled in insurance verification and patient communication. Manages complex precertification requests, ensuring compliance with insurance requirements while enhancing patient care. Delivers accurate documentation and resolves issues to streamline operations and improve approval timelines.
Overview
12
12
years of professional experience
Work History
Precertification Specialist
Resolve Pain Solutions-REMOTE
Memphis, TN
07.2025 - Current
- Coordinated precertification requests for various medical procedures and services.
- Reviewed patient records to ensure compliance with insurance requirements.
- Communicated with healthcare providers to clarify documentation and information.
- Managed patient follow-ups regarding precertification status and updates.
- Utilized electronic health record systems for efficient data retrieval and management.
- Collaborated with insurance companies to resolve precertification issues promptly.
- Maintained accurate records of all precertification requests and communications.
- Assisted team members in understanding precertification processes and guidelines.
- Verified insurance eligibility, coverage levels, and benefit parameters prior to submission of precertification requests.
- Collaborated with other departments within the organization as needed to resolve issues or obtain additional information.
- Assisted with answering provider inquiries regarding preauthorization requirements and processes.
- Compiled and submitted precertification requests for review by payers in accordance with established timelines.
- Resolved any discrepancies identified during the precertification process.
- Ensured compliance with all HIPAA regulations pertaining to protected health information.
- Evaluated clinical criteria against existing health plan guidelines to determine authorization status.
- Researched current payer policies related to specific services or diagnoses as needed.
- Explained reasons behind application denials and recommended further action.
- Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
- Communicated with patients with compassion while keeping medical information private.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Answered telephones and directed calls to appropriate medical or administrative staff.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Routed laboratory or diagnostic results to appropriate staff.
- Communicated with clients to gather necessary documentation and information.
- Utilized Availity platform for managing insurance verification and claims processing.
- Mycgs
- USDOL
- Workers Comp
- Rivet
- ECW
- Precert Pain injections
- MRI'S
- XRAYS
- Submit and track prior authorization requests for orthopedic procedures/imaging/DME, pain management interventions (injections, RFAs, SCS), and PT/OT therapy visit blocks.
- Review clinical documentation (EHR progress notes, MRI reports, conservative treatment histories) to ensure it meets payer-specific medical necessity criteria.
- Utilize insurance portals (Availity, NaviNet, Carelon, CoverMyMeds, worker's comp portals)
- Schedule and facilitate Peer-to-Peer (P2P) reviews between treating providers and insurance medical directors when initial requests are face-to-face denied.
- Verify patient benefits, co-pays, deductibles, and visit limits for PT/OT services to ensure transparent patient communication.
Denials & Appeals Management - Identify, investigate, and appeal prior authorization denials in a timely manner.
Document all authorization numbers, effective dates, approved unit/visit counts, and notes meticulously within the Electronic Health Record (EHR) system.
Precertification Specialist
Elkhart Clinic-REMOTE
Elkhart, Indiana
07.2014 - 06.2025
- Worked remote
- Appeals
- Estimates
- Worked in ECW
- Worked in Availity
- Precert surgery procedures (EGDs, Colonoscopy's, Injections, etc)
- Type notes and referrals
- Lookup and add CPT/DX codes
- Obtain authorizations
- Communicate with various insurance companies, online and phone
- Check benefits and eligibility
- Initiate authorization for outpatient surgery
- Call patients to let inform them of their Out of pocket cost
- Communicate with nurse
- Calculate amount payable
- Communicated with Commercial, Medicare, Medicaid and Supplemental insurance
- Made sure authorization was approved before scheduling
- Precert IV infusions
- Answer clinical questions for the insurance company
- Communicated with healthcare providers to clarify documentation and information.
- Maintained detailed documentation of all activities related to the precertification process.
Education
Some College (No Degree) - Undecided
Ivy Tech Community College of Indiana
Indianapolis, INSkills
- Precertification processes
- Electronic health records
- Insurance verification
- CPT and diagnosis coding
- Appeals management
- Patient communication
- Healthcare collaboration
- Data management
- Problem resolution
- Time management
- Team collaboration
- Documentation accuracy
- Medical coding
- Professionalism and ethics
- Medical terminology proficiency
- Strong communication skills
- Insurance verification expertise
- HIPAA compliance awareness
- Prior authorization
- Electronic health records management
- Telephone communication
- Data entry
- Documentation management
- Eligibility procedures
- Microsoft office
- Documentation and reporting
- Medicaid
- Knowledgeable in Availity
- Confidentiality
- Verbal communication
- USDOL website
- Workers Comp
- Rivet
- MyCGS website
- Appeals
- Medicaid
- Clinical documentation
- Patient care coordination
- Professionalism
Timeline
Precertification Specialist
Resolve Pain Solutions-REMOTE
07.2025 - Current
Precertification Specialist
Elkhart Clinic-REMOTE
07.2014 - 06.2025
Some College (No Degree) - Undecided
Ivy Tech Community College of Indiana