Ellkisha Little
Cape Coral,FL
Summary
Detail-oriented and highly organized Authorization Specialist with 7 years of experience in securing and managing insurance authorizations, ensuring compliance with healthcare regulations, and facilitating seamless patience care. Proven ability to resolve authorization challenges effectively, exceeding daily productivity, quickly learn new processes, and maintain accurate documentation. Skilled in TruCare, TruCare Cloud, Amisys, and Filenet. Dedicated to providing efficient, detail-oriented support in a fast-paced environment.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Authorization Research Specialitst
Centene
12.2022 - Current
- Proficient and accurate data entry
- Trained colleagues in specialized software programs, increasing departmental productivity through optimized workflows.
- Auth data entry for inpatient/outpatient prior authorization
- Performs varies duties and activites as assigned
- Exceeded daily production goal of 30 or more.
- Assisting and resolving complex authorization inquiries and inaccuracies
- Have worked Turning point auths, Alere, Market Place, Ambetter,SSBCI, denial letters, Evv, Cada, and vertexing
Authorization Specialist
Advanced Pain Management
01.2020 - 12.2022
- Contacting insurances (by phone, e-mail and regular mail) for eligibility, benefits, network status and authorization, documenting information
- Verify eligibility within the database system to members and providers
- Analyze faxed requests and documentation to determine coverage and approval utilizing criteria; utilize nurses for medical reviews when necessary
- Process requests for Prior Authorization
- Acts as a liaison between the payer and clinic schedulers/medical support staff
- Code each diagnosis of service and procedures according to standards
Authorization Specialist/Operator
Gardner Orthopedics
03.2017 - 07.2019
- Verify patient insurance
- Complete surgical & procedure estimate
- Input insurance benefits
- Notify patients of deductibles and co-insurance due
- Verify and update daily schedule
- Knowledge of EMR/Intergy
- Fax documents
- Set up peer to peers
- Monitor and track authorizations
- Obtain authorizations-20+ per day
- Set up medication delivery with patient specialty pharmacy
- Identify all CPT/ ICD codes associated with patient's procedures
- Answer incoming calls
- Transfer calls to the appropriate department
- Input patient demographics
- Knowledge of medical terminology
Education
Optometry -
Hillsborough Community College
Tampa, FL01-2007
Skills
- Data collection
- ICD and CPT coding knowledge
- Authorization Denials
- ICD-10 coding knowledge
- Medical coding familiarity
- Data entry proficiency
- HIPAA compliance
- Claim submission
- Insurance confirmation
- Authorization building
Certification
Medical Billing and Coding program
Timeline
Authorization Research Specialitst
Centene
12.2022 - Current
Authorization Specialist
Advanced Pain Management
01.2020 - 12.2022
Authorization Specialist/Operator
Gardner Orthopedics
03.2017 - 07.2019
Optometry -
Hillsborough Community College
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