Diann Sims
Parsippany,NJ
Summary
Prior Authorization Specialist with a proven track record at AMG Gastroenterology at Morristown, showcasing expertise in medical coding and insurance verification. Experienced in prior authorization within healthcare settings, handling tasks such as ensuring accuracy of patient insurance information and obtaining necessary approvals for medical procedures. Demonstrates strong skills in administrative work, documentation management, and fostering effective communication between patients, providers, and insurance companies. Known for problem-solving capabilities, precision in task completion and ability to positively impact workflow efficiency.
Overview
21
21
years of professional experience
3
3
years of post-secondary education
Work History
Prior Authorization Specialist
AMG Gastroenterology at Morristown
Morristown , NJ
02.2019 - Current
- Utilized medical coding knowledge to accurately process and document authorization requests.
- Assisted healthcare providers with appeals for denied authorizations, including gathering additional information and documentation.
- Provided guidance to providers regarding the prior authorization process.
- Collaborated with insurance companies to clarify coverage details and resolve issues related to prior authorization.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Maintained positive working relationship with fellow staff and management.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Followed up on pending prior authorization requests to ensure timely processing.
Business Office Supervisor
Medical Office Associates
435 South Street Suite 230A, NJ
08.2020 - 09.2024
- Manage front desk Medical Office Associates
- Greet patients and address their concerns
- Coordinate Providers schedule and block template accordingly
- Handle payroll for the department payroll and time off
- Conduct monthly team meeting for staff
- Daily intake of end of the day copays apply to Quickbase and TOS
- Daily check of Prior Authorization and Call Center team and address any concern with patients and procedure
- Coordinate meeting and lunches for the staff and send out invites
- Interview new candidates for positions within the department and send out invites
- Daily check on RFI on status on missing authorizations on referral and GI procedures
Medical Office Associate
Atlantic Digestive Health
Morristown, NJ
01.2019 - 01.2020
- Greet patients when they arrive at the office and provide them with any necessary paperwork or other information
- Answer multi-line phone system and take appointments or direct calls to the appropriate party
- Schedule appointments and confirm appointments two days in advance
- Verify insurance coverage and assist the billing department with processing claims
- Collect co-pays and other fees required prior to the office visit or treatment
Medical Office Associate
Pulmonary and Allergy Associates
Summit, NJ
02.2018 - 01.2019
- Answered and managed incoming and outgoing calls while recording accurate messages
- Screened all visitors and directed them to the correct employee or office
- Collected deposits, fees and payments
- Greeted numerous visitors, including VIPs, vendors and interview candidates
- Received and processed medical records requests
Referral and Insurance Coordinator
West Orange, NJ
05.2016 - 02.2018
- Completed up to 35 referral requests each day for a medical provider and any type of direct medical equipment services
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity
- Called insurance companies to get certifications and other benefits information on behalf of patients
- Screened and sorted incoming mail, faxes, and deliveries and routed them to the appropriate personnel
- Weighed patient need, provider availability and insurance coverage to determine optimal scheduling
Office Assistant
Livingston, NJ
12.2003 - 05.2006
- Scheduled procedures, surgeries and doctor appointments for an average of 30-40 patients per day
- Developed strong working relationships with management and the executive team through effective scheduling and communication skills
- Processed and approved all scheduling changes to the executive calendars by using Cerner
Education
Associates of Science (A.S.) - PUBLIC HEALTH
County College of Morris
Randolph Township, NJ 01.2022 - Current
Skills
- Insurance Verification
- Excellent Communication Skills
- Organized
- Adaptable
- Filing and data archiving
- Team Building
- Medical appeals handling
- Medical coding expertise
- ICD-10 coding
- Billing procedures
- Medical terminology
- Retro-authorizations
- Medical terminology knowledge
- Records maintenance
Timeline
Associates of Science (A.S.) - PUBLIC HEALTH
County College of Morris
01.2022 - Current
Business Office Supervisor
Medical Office Associates
08.2020 - 09.2024
Prior Authorization Specialist
AMG Gastroenterology at Morristown
02.2019 - Current
Medical Office Associate
Atlantic Digestive Health
01.2019 - 01.2020
Medical Office Associate
Pulmonary and Allergy Associates
02.2018 - 01.2019
Referral and Insurance Coordinator
05.2016 - 02.2018
Office Assistant
12.2003 - 05.2006
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