Heather Matherly
Evansville,IN
Summary
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 17 years of managing documentation. Considered team player with exemplary multitasking skills.
Overview
20
20
years of professional experience
Work History
Prior Authorization Specialist
Ascension St. Vincent Medical Group Urology
07.2006 - Current
- Input all patient data regarding prior authorizations into system accurately.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Developed and maintained productive working relationships with healthcare providers.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- Processed patients lacking coverage for planned procedures.
- Communicated with people from various cultures and backgrounds on application process.
- Assisted clients with completion of applications and paperwork.
Project Worker
Deaconess Hospital
04.2003 - 07.2006
- Interacted with hospital staff, patients, and families to demonstrate good customer service techniques.
- Utilized chemicals and cleaning equipment to meet facility's predetermined sanitation and cleanliness quality standards.
- Cleaned and disinfected patient exam rooms, surgery suites, and common areas to promote sanitary treatment and services environment.
- Removed hazardous and medical waste from exam rooms, treatment rooms, and surgery suites to minimize risks to patients and medical personnel.
- Wore necessary personal protective equipment to minimize risks from hazardous materials, biohazards, and other harmful substances.
- Used chemicals by following safety protocols and procedures to avoid burns and injuries.
- Emptied trash cans and recycling bins to promote clean, sanitary environment, and reduce odors and debris.
- Practiced established infection control methods to reduce risks to patients, families, and medical staff.
- Verified cleanliness and organization of storage areas and carts.
- Disposed of trash and recyclables each day to avoid waste buildup.
- Cleaned and stocked guest rooms by replacing used towels and linens vacuuming floors, making beds, and restocking bathroom items.
- Moved chairs, desks, and beds around rooms to clean behind and underneath furniture.
- Slid beds, sofas, and other furniture aside to wipe down baseboards and remove dust and dirt from hard-to-reach areas.
- Complied with applicable standards during cleaning of specialty areas such as labs, surgery suites and labor and delivery rooms to maintain exceptional level of cleanliness.
- Restocked room supplies such as facial tissues for personal touch with every job.
- Cleaned elevators, glass, and planters in public areas.
- Trained new employees on departmental procedures and provided assistance in finding cleaning supplies.
- Removed waste paper and other trash from premises to designated area.
- Documented and reported necessary facility and building repairs observed.
- Operated electronic backpack vacuums and floor sweepers.
Education
Certificate - Medical Office
Ivy Tech Community College
Evansville, IN08.2006
Certificate - Interior Design
Ivy Tech Community College
Evansville, IN01.2001
Skills
- Explaining Patient Benefits and Cost Estimates
- Health Insurance Plan Knowledge
- Benefit Coverage
- Diagnostic Codes
- Treatment Documentation
- Outpatient Procedures
- Patient Scheduling
- Patient Identification
- Call Transfers
- Outpatient Surgery Coding
- Demographics Information
- Benefits Verifications
- Insurance Procedures
- Greeting Visitors
- Authorizations
- Retro-Authorizations
- Customer Satisfaction
- Registration Processes
- Registration Paperwork
- Effective Communication Skills
- Status Updates
- Patient Referral
- Medical Terminology
Timeline
Prior Authorization Specialist
Ascension St. Vincent Medical Group Urology
07.2006 - Current
Project Worker
Deaconess Hospital
04.2003 - 07.2006
Certificate - Medical Office
Ivy Tech Community College
Certificate - Interior Design
Ivy Tech Community College
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