Jane Woerner
Finchville,KY
Summary
Proactive Medication Prior Authorization Specialist and Dispensary Technician with extensive experience collaborating with physicians and insurance carriers to secure necessary authorizations. Expertise in insurance verification, medical appeals handling, and maintaining compliance with HIPAA and state regulations. Proven ability to streamline processes and provide training to enhance operational efficiency.
Overview
16
16
years of professional experience
Work History
Medication Prior Authorization Specialist
Dr. Lawrence Peters
01.2013 - 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.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
- Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
- Participated in cross-functional initiatives to improve overall efficiency and effectiveness of the prior authorization process for all involved parties.
- Streamlined prior authorization processes by implementing efficient tracking systems.
Dispensary Technician
Dr. Lawrence Peters
09.2008 - 01.2013
- 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.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Streamlined dispensary operations by efficiently managing inventory and maintaining accurate record-keeping systems.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
- Entered and processed patients' prescriptions into internal system.
- Ensured regulatory compliance by adhering to state laws, company policies, and industry best practices for dispensary management.
- Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
Education
Associate of Applied Science - Accounting
Jefferson Community College
Louisville, KY05.1990
Skills
- Prior Authorization Process
- ICD-10 Coding Familiarity
- Medical Terminology
- Medical Appeals Handling
- Insurance Verification
- Effective communication skills
- Medicare and Medicaid knowledge
- HIPAA Compliance Knowledge
- Electronic Health Records Proficiency
- Medical terminology knowledge
- Data Entry
Accomplishments
I became a Nationally Certified Pharmacy Technician and was honored to become the first Pharmacy Technician of the Year for the state of Kentucky in 2000/2001.
I was also awarded Regional Pharmacy Technician of the Year for Walmart.
JCAP (Jefferson County Association of Pharmacists) - I served on the board for several years, first as assistant of the Continued Education Committee and lastly as Secretary of the board
Hobbies include Ancestry and Family Trees, Crafting (making greeting cards)
My hobbies include working on family trees through ancestry.com. I also love crafting (scrapbooking and making greeting cards). I enjoy going on cruises for vacation.
Additional Information
I am able to work in office or remotely.
Timeline
Medication Prior Authorization Specialist
Dr. Lawrence Peters
01.2013 - Current
Dispensary Technician
Dr. Lawrence Peters
09.2008 - 01.2013
Associate of Applied Science - Accounting
Jefferson Community College
Similar Profiles
Lisa PetersLisa Peters
Practice Coordinator at Dr. Thomas G. Peters, LLCPractice Coordinator at Dr. Thomas G. Peters, LLC
Thomas PetersThomas Peters
Chiropractor/Business Owner at Dr. Thomas G. Peters, LLCChiropractor/Business Owner at Dr. Thomas G. Peters, LLC
Serena MischoSerena Mischo
Nanny at Dr. Darrick And Haley PetersNanny at Dr. Darrick And Haley Peters