Helen Hughes
Summary
Accomplished Authorization Specialist with a proven track record at Summit Medical Group/Village MD, achieving a high success rate in prior authorizations through expert medical coding knowledge and exceptional verbal communication. Skilled in insurance verification and team building, adept at navigating complex healthcare regulations to deliver results efficiently.
Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level position. Ready to help team achieve company goals.
Overview
12
12
years of professional experience
Work History
Authorization Specialist
Summit Medical Group/Village MD
07.2018 - Current
- Collaborated with 13 physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for 13 service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Provided training to 10 new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- Supported 10 team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Facilitated cross-departmental training sessions to enhance understanding of prior authorization criteria and procedures.
Radiology Clerk
Robert Wood Johnson Barnabas Health
03.2012 - 07.2018
- Educated patients on procedure details, provided instructions, and answered questions to minimize anxiety and improve cooperation.
- Enhanced patient experience by efficiently managing radiology appointment scheduling and handling inquiries.
- Demonstrated professionalism and adaptability by effectively handling multiple tasks simultaneously while maintaining a high level of accuracy and attention to detail.
- Assisted in training 5 new Radiology Clerks, ensuring quick proficiency in departmental procedures and protocols.
- Provided exceptional customer service to both internal and external clients through prompt response to inquiries via phone calls or email correspondence related to radiology services.
- Managed patient flow within the radiology department by coordinating appointment bookings, walk-ins, and emergency cases to ensure timely service delivery.
- Maintained confidentiality of sensitive patient information in compliance with HIPAA regulations, fostering trust between patients and the healthcare facility.
- Performed various administrative tasks by filing, copying and faxing documents.
- Greeted and interacted with 30+ patients daily to provide information, answer questions and assist with appointment scheduling.
- Obtained payments from patients and scanned identification and insurance cards.
Education
Certification - Certified Clinical Medical Assistant
National Health Career Association
East Orange, NJHigh School Diploma -
John F. Kennedy High School
Paterson, NJSkills
- Medical terminology expertise
- Claims Management
- Insurance Verification
- Medical coding knowledge
- HIPAA Compliance
- Prior authorization processing
- Verbal Communication
- Problem-solving abilities
- Organizational Skills
- Team building
- Administrative Management
- Authorizations understanding
Timeline
Authorization Specialist
Summit Medical Group/Village MD
07.2018 - Current
Radiology Clerk
Robert Wood Johnson Barnabas Health
03.2012 - 07.2018
Certification - Certified Clinical Medical Assistant
National Health Career Association
High School Diploma -
John F. Kennedy High School
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