Elizabeth Koch
Aurora,Illinois
Summary
Professionally trained Authorization/Referral Specialist skilled in providing excellent customer service, expertise in problem-solving, conflict resolution, communication, and multitasking.
Reliable professional offering an extensive career promoting positive customer experiences. Sharp Eligibility Specialist boasting expertise in managing and eligibility information for members and groups.
Overview
25
25
years of professional experience
Work History
Referral/Authorization Specialist
Edward Hospital
Naperville, Illinois
01.2020 - Current
- Reviews open status referral report/Epic work queues daily and processes referrals to approved, closed or incomplete status based on established policy
- Ensures complete and accurate registration, including patient demographic and current insurance information
- Addresses questions and concerns with patients regarding their referrals and sets guidelines and expectations about the NS_EEH referrals process
- Utilizes online tools to research criteria to verify insurance coverage and need for preauthorization
- Communicates professionally with insurance companies, patients, primary care physicians, specialists and/or facilities regarding authorization as needed
- Works with the provider to ensure the procedure has correct coding and is approved prior to initiation of procedure/test/treatment
- Establishes, develops, and maintains good working relationships with hospital departments, health plan representatives and physician office personnel to ensure timely transfer of information to complete the authorization process and promote goodwill
- Documents all referral information in Epic
- Ensures strict confidentiality of all health records, member information and meets HIPAA guidelines
- Serve as a Covid Labor Pool Team Lead
- Utilizes Rhyme Live-Auth application to achieve real-time authorization
- Mentored/Trained new employees.
Referral Specialist 2/Mentor
Aim Specialty Health
Westchester, Illinois
01.2017 - 01.2019
- Responsible for providing support to a clinical team to facilitate the administrative components of clinical referrals for various AIM services
- Primary duties include initiating and managing clinical referrals for pre-authorization, reviewing referrals for completeness and follows up for additional information if necessary, and responding to inbound calls, initiating exam requests, following established processes, meeting quality and production standards
- Assigns escalated referrals to staff as appropriate
- Verified insurance coverage and completes pre-authorization for surgical and high-tech radiology (CT, MRI, PET, etc.) while following established process and procedures
- Screened Pre-authorization requests using approved criteria and guidelines
- Maintained telephone service standards in accordance with departmental guidelines
- Served as training mentor to new personnel after six months of employment.
Polysomnography Technologist
Advocate Good Samaritan Hospital
Downers Grove, IL
01.2003 - 01.2017
- Performed attended polysomnograms, MSLT, CPAP, BIPAP, VPAP and O2 titrations
- Performed polysomnograms on research patients using specific protocols
- Interviewed patients and document medical information including history
- Completed new patient files and update information for existing patients
- Effectively educate and communicate with patients regarding pre-testing, testing and post-testing procedures
- Completed Set-up process for diagnostic testing
- Educated patients regarding use and benefits of positive airway pressure and sleep disorders
- Performed direct patient care while maintaining a safe environment
- Completed patient check-in/check-out procedures
- Completed equipment maintenance, troubleshooting, and calibrations as necessary
- Prepared (score) studies for physician review, diagnosis, and dictation
- Maintained inventory of lab supplies
- Served as lab 'Safety Champion' to ensure safety measures and practices are established for patients and staff
- Completed staff schedules
- Completed training and orientation of new personnel.
Communications Operator
Advocate Good Samaritan Hospital
Downers Grove, IL
01.1999 - 01.2003
- Effectively managed a high volume of inbound/outbound customer calls
- Referred unresolved customer grievances to designated departments for further investigation
- Managed customer calls effectively and efficiently in a complex, fast-paced call center environment
- Accurately document, research and resolved customer service issues
- Maintained the electronic personnel directory for accuracy
- Completed training and orientation of new personnel.
Security Forces Specialist
United States Air Force
01.1999 - 01.1999
- Ensure the safety of all base weapons, personnel, and property
- Direct air bases defense functions and lead individual and team exercises
- Conduct investigations into any on-base incidents
- Train handlers and military work dogs
- Apprehend and detain suspects, secure crime scenes, and testify in judicial proceedings
- Apply life-saving procedures as first responders to disaster scenes
- Participate in team patrol movements, tactical drills, battle procedures, and military operations other than war.
Education
Human Resources -
Southern New Hampshire University
05.2024
Leadership -
Harvard University
05.2024
Polysomnography Training Course -
Midwest Sleep & Neurodiagnostic Institute
12.2003
Skills
- PSG
- MSLT
- CPAP
- BIPAP
- VPAP
- O2
- Proficient in Sandman
- Alice
- Somnoware Sleep Software
- Microsoft Office including Word
- Excel
- PowerPoint
- Adobe Office Suite
- Charting and Documentation
- Prior Authorization
- Clinical research
- Train personnel in all aspects of polysomnography
- Excellent communication skills
- Customer service oriented
- Accurate/Detailed/Efficient
- Excellent planner/Coordinator/Multi-tasker
- Medical terminology knowledge
- Collaborative team player
- Insurance Verification
- Medical terminology expertise
- HIPAA Compliance
- Documentation and paperwork
- Effective communication skills
- Recordkeeping and data input
- Application assessment
- Knowledgeable in Epic
- Telephone Etiquette
- Medicaid knowledge
- Confidentiality
- Microsoft Office
- Documentation And Reporting
- Interpersonal Skills
- Document Preparation
- Self Motivation
- Multitasking
- Effective Communication
- Authorizations knowledge
- Audit Support
- Time Management
Timeline
Referral/Authorization Specialist
Edward Hospital
01.2020 - Current
Referral Specialist 2/Mentor
Aim Specialty Health
01.2017 - 01.2019
Polysomnography Technologist
Advocate Good Samaritan Hospital
01.2003 - 01.2017
Communications Operator
Advocate Good Samaritan Hospital
01.1999 - 01.2003
Security Forces Specialist
United States Air Force
01.1999 - 01.1999
Human Resources -
Southern New Hampshire University
Leadership -
Harvard University
Polysomnography Training Course -
Midwest Sleep & Neurodiagnostic Institute
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