Summary
Overview
Work History
Education
Skills
Education and Training
Timeline
Generic

Jada Cortez

Thibodaux,LA

Summary

Diligent Prior Authorization Specialist with proven track record in navigating complex healthcare systems and ensuring timely approval of medical treatments. Successfully facilitated seamless communication between providers and insurance companies to streamline authorization processes. Demonstrated expertise in medical authorizations and patient advocacy.

Overview

6
6
years of professional experience

Work History

Prior Authorization Specialist

Option Care Home Infusion
08.2024 - Current
  • Collaborated with 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.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Analyzed medical records and other documents to determine approval of requests for authorization.
  • Reached out to insurance carriers to obtain prior authorization for testing and procedures.
  • Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
  • Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
  • Responded to inquiries from healthcare providers regarding prior authorization requests.
  • Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.

Prior Authorization Specialist

Cardiovascular Institute of the South
08.2022 - 08.2024
  • Facilitated communication between providers, payers and health plans regarding prior authorization processes.
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
  • Maintained positive working relationship with fellow staff and management.
  • Notified ordering providers of denied authorizations.
  • Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
  • Reviewed prior authorization requests to ensure accuracy and completeness of required information.
  • Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
  • Coordinated with other departments to obtain additional information needed for prior authorization.
  • Maintained accurate records of all authorization activities in the database system.
  • Completed day-to-day duties accurately and efficiently.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations.

Medical Assistant

Thibodaux Regional Health Systems
05.2019 - 01.2022
  • Assisted with pre-operative preparation of patients including providing instruction about post-operative care plans.
  • Educated patients about medications, procedures and physician's instructions.
  • Monitored vital signs of hospitalized patients throughout their stay at the hospital or clinic setting.
  • Communicated with pharmacies for prescription refills on behalf of supervising physician.
  • Documented notes during patient visits.
  • Oversaw patient registration, insurance verification, form completion and appointment scheduling to maintain operational efficiency.
  • Conducted insurance verification and pre-certification and pre-authorization functions.

  • Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
  • Educated patients on healthcare topics such as nutrition and disease prevention methods.
  • Maintained accurate medical records through filing, charting, transcription and data entry into electronic health record system.
  • Administered injections, medications and treatments as directed by the physician.

Education

Certificate Of Completion - Medical Assisting

Blue Cliff - Houma
Houma, LA
05-2019

Skills

  • Understanding of Medical Terms
  • Pharmacology
  • Insurance Information Oversight
  • Insurance Procedures
  • Effective Communication Skills
  • Precertification Requirements
  • Prior authorization process / Authorizations
  • Insurance verification
  • Data entry
  • Effective communication skills
  • Medical appeals handling
  • Medical terminology

Education and Training

other

Timeline

Prior Authorization Specialist

Option Care Home Infusion
08.2024 - Current

Prior Authorization Specialist

Cardiovascular Institute of the South
08.2022 - 08.2024

Medical Assistant

Thibodaux Regional Health Systems
05.2019 - 01.2022

Certificate Of Completion - Medical Assisting

Blue Cliff - Houma

Similar Profiles

CREATE PROFILE