DULCINAYA CHURCH
Pittsburgh,PA
Summary
Hardworking Prior Authorization Specialist with successful background working closely with clients, Speech Language Pathologists, and insurance company representatives to gain preapproval for DME services. I strongly believe in my role as a patient advocate. Detail-oriented performer with over 2 years of managing medical documentation. I am knowledgeable in regulatory standards and compliance requirements. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
2
2
years of professional experience
Work History
Funding Consultant II
Tobii Dynavox
06.2022 - Current
- Enhanced communication among team members, fostering a collaborative and supportive work environment.
- Collaborated with cross-functional teams to successfully deliver comprehensive solutions for clients.
- Delivered outstanding service to clients to maintain and extend relationship for future business opportunities.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Identified trends in denials through data analysis, adapting strategies accordingly for improved success rates in obtaining approvals.
- Established strong relationships with key contacts at insurance companies, streamlining communication channels when resolving issues pertaining to approvals or denials.
Education
Associate Degree in Social Science -
CCAC Pittsburgh
05.2021
Skills
- Interpersonal Communication Skills
- Mediation and Negotiation Skills
- Microsoft Office
- Continuous Improvement
- Attention to Detail
- Processes and procedures
- Client Relationships
- HIPAA Compliance Knowledge
- Issue Research
Accomplishments
- Collaborated with medicaid representatives to open up previously restricted places of service, so clients in nursing homes, SNFs, and ICFs could receive speech generating devices. This has generated over $100,000 in additional revenue since implementation.
- Proactively worked to create resources in areas of client communication that needed additional support.
Affiliations
- DE&I Committee
Timeline
Funding Consultant II
Tobii Dynavox
06.2022 - Current
Associate Degree in Social Science -
CCAC Pittsburgh