Elizabeth Agostini

Work History

Authorization/ Referral Lead Supervisor

UF Health – Proton Therapy Institute

12.2021 - Current

Work new patient cases sent from Intake dept for authorization
Confirm insurance(s) and verify eligibility and benefits
Use Mosaiq QCLs to monitor patient status throughout auth process
Use EPIC EMR system to work accounts and communicate with other facilities
Use various insurance provider portals for authorizations (Availity, New Century Health, UHC, etc...)
Contact patient regarding cost for consult and potential radiation therapy
Note specific authorization requirements based on insurance medical guidelines and specify which radiation treatment modalities will be covered
Request referral for new patient consult or follow up visit from PCP if required
Print daily report of patients starting treatment or have upcoming office visit to ensure accuracy
Obtain authorization for scope if used in office visit
Confirm diagnosis and treatment modality after consult in order to plan tx auth request
Confirm if authorization is required for all treatment CPT codes, planning codes and ancillary codes via radiation oncology medical policies
Inform physician, dosimetry, physics and radiation therapists if comparison plan is required by plan
Create patient responsibility document detailing estimated cost for treatment
Inform self-pay patients of cost for treatment, imaging, appointments or any other office procedure
Confirm all pertinent medical documentation is in patients' charts from other offices and continue with in house documentation needed to submit for radiation therapy authorization
Lead weekly staff huddle to discuss areas of improvement and have open discussion about cases
Keep patient informed of authorization status throughout processing
Note specific and detailed notes in patients chart regarding auth process and all communication with insurance company and patient
Re verify insurance(s) first of each month for marketplace and medicaid plans
Fax pre determination if authorization is not required to confirm insurance coverage
Audit all treatment cases from staff of five before sending to billing to ensure easy claims processing
Confirm diagnosis is covered on Medicare LCD list for all treatment modalities and note specifics
Enter authorization details for office visit and/or treatment into Mosaiq and EPIC
Communicate with other departments regarding patient care and treatment
Take all patient complaint calls and work complicated cases that need more attention than others
Updated templates for LOMNs (letter of medical necessity) by tx site to assist providers and encourage specific dictation practices to assist in obtaining approvals on first submission

Financial Counselor & Authorization Specialist Team Lead

Ackerman Cancer Center

Jacksonville

02.2019 - 10.2021

Outsourced to third party
Meet patients at consults to discuss insurance benefits if Proton Beam or IMRT (traditional radiation treatment) is needed
Set up payment plan for patients that fit their financial situation and treatment time
Help patients apply for charity/hardship agreements and see if they qualify for percentage of bill(s) to be written off by the office
Created Standard of Practice guides for the Intake Coordinator for new patient consults
Created Seven documents relating to the financial assistance / hardship program and which to use for a patient’s particular situation
Created a Medicaid Share of Cost plan explanation for patients and family that are not clear on this plan type
Staff used it as well for their own knowledge
Created the Hardship Agreement requirements and updated the policy itself which is in use
Created “Attempt to Contact” letter for patients that need to update their payment plan status or cannot be reached and we need documentation to be in compliance
Give paperwork discussing required documents needed to validate hardship agreement to show proof of income
Meet with patients at any appointment that have questions about their existing statement or insurance benefit details regarding treatment
Contact patient to inform copay cost for upcoming appointment based on their insurance
Run patient’s credit/debit cards each month per their payment plan scheduled date to pay
Contact patients that have existing balances to set up payment arrangements
Inform self-pay patients of cost for treatment, imaging, appointments or any other office procedure
Keep front desk employees trained on how to collect copays and confirm amount via insurance website
Take payments over the phone and try to educate patients on creating their own recurring payment plan via online website option
Adjust patient statements after claims are processed based on their hardship percentage
Notate Mosaiq and G4(Centricity) billing system of all actions pertaining to patient billing or communication
Make sure Mosaiq and G4 system show patient is on hardship agreement or payment plan
Have patients re apply for hardship after one year expiration date
Submit for radiation therapy treatment authorizations: Protons, IMRT, HDR/Brachy, SRS, SBRT
Electrons, 3D for all ACC patients being treated at Mandarin and Amelia Island office
Follow up with insurance companies on auth requests, submit appeals, and setup peer to peer calls
Make accurate and detailed notes in G4 and Mosaiq as far as auth submission, auth status and approval number, denial reference number, or no authorization required reference number
Educate the patient on the authorization process based on their insurance’s guidelines and what will be needed in order to obtain a timely approval
Request a comparison plan showing out of QUANTEC for certain health plans that will not automatically approve
This can be Protons.vs.IMRT.3D in various comparisons
Back up for imaging authorizations: PET, CT, MRI, Lupron/Eligard, Iodine-I 131, Biopsies, etc...
Make sure front desk was well versed in how to speak to patient regarding copay, remaining balance or asking about authorization details
Created SOP documents for: Reminder calls, Collection of copays, Insurance tips and tricks and streamlined verbiage on AOB consent documents
I was the “go to” person for other departments when there was a question about billing, costs or authorizations
COO often spoke with me about standard of practice and how to streamline workflows due to my experience
Led a team of five with daily workflows, updating and streamlining specific job descriptions and led weekly front desk meetings to see if there are questions or concerns
Peer interviewer for new hires for front desk or billing office
Trained new staff in all cross training for authorizations of treatment and imaging as well as payments and financial counseling.

Authorization Specialist

Baptist Medical Center, Lyerly Baptist Neurosurgery

Jacksonville , FL

08.2018 - 09.2019

Quit due to personal reasons and safety issues
Obtain prior authorization(s) for scheduled brain and/or spinal surgeries, imaging (MRIs, MRAs, CTS
XRays, CTAs, PET, Angiograms, Myelograms, Etc) and referrals
Contact insurance companies to verify eligibility and benefits for both Lyerly (Specialist physician) and facility (Baptist Medical)
Use various portals: Availity, UHC, Navinet, Humana Military, Medicaid, Evicore, NIA, UMR, Aetna
Cigna, Etc..
To obtain benefits and/or authorization(s)
Work closely with medical assistants to make sure all procedure code(s) and diagnosis code(s) are correct for requested authorization
Update Excel spreadsheet of weekly surgeries and status of each procedure on share drive
Also emailed to office manager, at the end of each week
Keep in contact with patient there are any questions or concerns regarding guidelines of their insurance and turnaround time for determination
Goal: Have surgery requests initiated 30 day out
Surgeons will "add on"
Send all clinical documentation for surgery to be approved (ie: office notes, onset of pain, conservative treatment, recent imaging, other facility office notes, etc): each insurance has its' own guidelines and require different or additional documentation
Expedite all cases if necessary
Organize and file initiated cases in order to check status and sort by date for status checks
Approval received: Notate GPMS and add the authorization details to appointment
Scan approval to patient’s chart
Update Excel spreadsheet
Update surgical template doc from medical assistant (how I start each case) an email the valid authorization info to PAS at hospital and to MA to inform the patient
Denial received: Speak with insurance for details of denial
Speak with medical assistant to see if I should appeal or request a “Peer to Peer" between Lyerly surgeon and medical director of insurance company to get denial overturned
Inform surgeon and medical assistant if approval has been received 48hrs before surgery date (per facility guidelines) -usually done through email for paper trail
Inform the hospital of any: cancellations, reschedules, updating authorizations due to new date of service
If insurance is out of network: request specific out of network authorization, once obtained
Forward to managed care team at the hospital to negotiate letter of agreement between facility and insurance
All must be obtained before the date of surgery
If needed: write an explanation on continuity of care that our cerebral vascular surgeons are the only in the area to perform specific brain procedure for spinal surgery
Inform patient if their insurance has an IOQ program (institute of quality) and if we are out of network, as if they would like to keep their appointment and use out of network benefits or find an in network facility
EMR (Allscripts computer program, used to process all imaging a referral orders that are to be performed outside of Baptist Medical locations
Reassign all orders to be "worked" so it is out of the unassigned and into Lyerly folder
Inform MAs and surgeons of status updates either by task and/or annotation
Approval received: update order and annotate progress notes on obtaining auth
Task medical assistant the details and say ok to schedule at particular outside facility
Denials sent from hospital : Fight to appeal and obtain approval

Authorization Specialist Team Lead

Glens Falls Hospital

Glens Falls , NY

07.2014 - 09.2018

Moved to Florida
Contact insurance companies via: fax, phone, or website for benefits and authorizations
Obtain medical authorizations for Inpatient and Observation admissions; ER and scheduled admits
Currently using Cerner (Access Management), RevCyle, and Powerchart for daily work flow
Familiar with: IDX/Centricity and 3M
Obtain priority ICD 10 code and CPT 4 procedure codes, NPIs for facility and doctors in order to obtain initial authorization and be as details as possible
Maintain and cross reference work lists for each type of admission to ensure no patient is missed
Ensure all encounters are registered correctly showing proper: insurance name, by plan type and claims address, insurance member ID and group number
Keep track of physician's orders per Powerchart and Error Reports printed throughout the day, to maintain correct authorization type, i.e: inpatient or observation
Track registration errors to train ER or pre scheduling staff
Log Medicare patients prior admit dates, deductible days and notate remaining coverage
Maintain weekly log of Medicare patients in house over thirty days; have LTR form if needed
Use websites daily for benefits and authorizations: CDPHP, Fidelis, UHC, Today's Options, Availity
Navinet, Evicore, Blue Cross, Blue Shield, MVP, Tricare/Humana Military, and several others
Maintain file of maternity stays until discharged; make sure no change of care for mom/baby and discharged within allotted days by insurance
Contact mothers to see if baby is being added to insurance or has state unborn Medicaid ID number
Daily contact with UR/UM department to give info on faxing clinical and any denials received
Speak with patient about inpatient copay amount or mail statement after discharge
Contact patient before scheduled surgery date to notify of copay
Maintain relationship with doctors' offices to obtain prior authorization for scheduled surgeries
Notate system of benefits (eff date, cp, ded, coins, opmx) and authorization status
Transaction Coordinator/Compliance: Same company – two different brokerages

Coldwell Banker Real Estate

Las Vegas , NV

01.2008 - 01.2015

Process Listings & Sales transactions daily
Receive closing packages from Title Company to process commission checks / Done Daily
Processed closing packages into different systems to make sure monetary values are compliant
Tab and make sure broker signs where required
Enter each transaction into CREST and Profit Power system
Keep Logs of Closings/Listings/Sales/Rentals/Terminations
Log and give checks to agents / All paperwork must be in file and correctly signed and dated to receive check
Keep track of Home Warranty used
Create and review all files / Certain paperwork required depending on the type of sales (thirteen different types)
Familiar with GLVAR and Coldwell Banker Forms
Work with ZipForms often
Processed individual agents files per their request for a separate fee
Understand Laws of Real Estate regarding transactions and paperwork
Revamped the entire compliance department
Update Transactions in: MLS, CREST & Profit Power: Withdrawal/Cancel/Price Change/Est
COE Date
Work with MLS website daily
Terminate agents and send license and paperwork to Nevada Real Estate Division
Return Licenses / Clear agent accounts if moneys owed at time of termination
Receive Commission Instructions / Fax to title once signed by broker
Multiple Office Duties: Answer phones, help with copier, printers, scanners, help agents with a variety of problems or issues
Update transaction board daily / write out properties and agent's name to be visible for entire office

Summary

Overview

Work History

Authorization/ Referral Lead Supervisor

Financial Counselor & Authorization Specialist Team Lead

Authorization Specialist

Authorization Specialist Team Lead

Education

Associate - Liberal Arts- Social Science

Skills

Additional Information

Timeline

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