Janice Crooks
Bethany,OK
Summary
Authorization Specialist experienced in prior authorization processing, insurance verification, and denial management. Achieved efficient communication between patients, healthcare providers, and insurance companies through thorough documentation and problem-solving skills. Focused on ensuring HIPAA compliance and identifying inconsistencies to enhance transaction accuracy.
Overview
28
28
years of professional experience
Work History
Authorization Specialist
SSM Health Medical Group
Oklahoma City, OK
01.2019 - Current
- Supported prior authorization processing for SSM Health Medical Group referrals and scheduled procedures.
- Assessed patient authorization requests for compliance with healthcare regulations to mitigate risks.
- Processed authorization requests promptly to reduce delays in patient care services.
- Communicated with healthcare providers to clarify authorization requirements.
- Collaborated with providers to resolve authorization issues and expedite patient services.
- Maintained accurate documentation of authorization requests and outcomes for compliance.
- Updated patient records promptly to reflect authorization status and relevant details.
- Collaborated with team members to streamline authorization processes and improve efficiency.
- Participated in team meetings to discuss workflow improvements and address challenges.
- Submitted authorization requests to managed care plans and tracked pending approvals.
- Updated physicians, patients, and scheduling staff on authorization status to facilitate care coordination.
- Updated authorizations, referrals, and coverage details in patient records.
- Resolved denial issues by gathering supporting records and payer requirements.
- Monitored authorization queues and followed up on time-sensitive requests.
- Tracked authorization statuses using electronic databases or manual filing systems.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Reviewed authorization requests for accuracy and completeness.
- Monitored daily workflow queues within the department ensuring all tasks are completed accurately and timely.
- Processed prior authorization requests to ensure timely patient care. requests in accordance with departmental guidelines.
- Ensured timely submission of accurate documentation to support payment of services rendered by providers.
- Participated in meetings with staff members from other departments such as billing and coding teams to provide clarification on policies related to authorizations.
- Prepared appeal letters on behalf of clients when necessary to resolve disputes with insurers.
- Entered data into electronic medical record system accurately and efficiently.
- Explained reasons behind application denials and recommended further action.
- Responded to client inquiries and concerns and escalated complex problems to department supervisors.
- Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
Bookkeeping Administrative Assistant
Oklahoma City Ear Nose & Throat Clinic
Oklahoma City, Oklahoma
01.2002 - 01.2019
- Updated and maintained financial records to ensure compliance and accuracy.
- Processed daily transactions accurately to streamline financial operations.
- Managed accounts payable and receivable for ear, nose, throat clinic records.
- Posted patient payments and updated billing entries in practice accounting systems.
- Maintained accurate filing systems for all accounting records, including invoices, receipts and payments.
- Tracked expenses and coded transactions for clinic bookkeeping accuracy.
- Verified accuracy of billing data and revised any errors prior to issuing invoices to customers.
- Conducted bookkeeping administrative tasks by filing documents and maintaining database updates.
- Performed data entry of financial information into accounting software programs.
- Managed daily bookkeeping functions with attention to accounts receivable, accounts payable, banking reconciliation and disbursements.
- Answered billing questions and routed account issues to appropriate staff.
- Resolved patient billing inquiries promptly to enhance customer satisfaction.
- Prepared and issued customer invoices, monitored receivables, and managed collections process.
- Assisted with month-end close processes including reconciling intercompany accounts and resolving discrepancies between actual results and forecasted figures.
- Managed vendor relations by promptly addressing inquiries regarding payment status and account balances, ensuring clear communication.
- Produced regular financial reports, including income statements and balance sheets, to inform management of clinic's financial performance.
- Performed daily cash transactions such as deposits, withdrawals, transfers, ensuring accuracy of all records maintained in the general ledger system.
- Calculated and produced checks for utilities, taxes and other operational payments.
- Ensured invoice accuracy by systematically matching orders with invoices for effective financial tracking. and recorded required information.
- Prepared bank deposits by verifying and balancing receipts and sending cash and checks to banks.
Administration Assistant
Oklahoma City Ear Nose & Throat Clinic
Oklahoma City, Oklahoma
02.1999 - 01.2019
- Assisted patients with insurance claims and explained coverage options effectively.
- Handled billing inquiries and resolved discrepancies, ensuring timely payment processing.
- Assisted with billing paperwork and claim support
- Coordinated communication by answering calls and delivering messages to clinic staff efficiently.
- Supported front desk operations and patient communication
- Provided administrative support to management team.
- Performed data entry tasks accurately within specified timeframes.
- Organized and maintained files, including electronic records.
- Maintained office integrity by systematically filing correspondence and managing document records.
- Delivered essential clerical assistance to enhance departmental efficiency and workflow..
- Processed incoming mail on a daily basis and responded to inquiries from internal and external customers in a timely manner.
- Processed financial documents, contracts, expense reports and invoices.
- Tracked and submitted employee timesheets to prepare for payroll processing.
- Monitored office equipment usage logs to ensure proper maintenance is performed.
- Oversaw office supplies inventory by monitoring stock levels, anticipating needs, placing orders, and confirming receipt.
- Answered phone calls and emails to provide information, resulting in effective business correspondence.
- Managed incoming communications by sorting and distributing faxes, letters, and emails to relevant departments..
Education
Administrative Assistant, And Accounting - Medical Administrative Assistant
Wright Business School
Oklahoma City, OK02-1999
Skills
- Prior authorization processing
- Insurance verification
- Claims processing
- Denial management
- Confidentiality
- Documentation skills
- HIPAA compliance
- Proficiency in Epic
- Medical records
- Data management
- Microsoft office
- Time management
- Detail orientation
- Problem solving
- Research skills
- Adaptability
- Multitasking
- Team collaboration
- Effective communication
- Communication skills
- Customer service
- Professionalism
- Policy interpretation
- Decision making
- Problem-solving
- Authorizations
- Problem solving
- Authorizations
Timeline
Authorization Specialist
SSM Health Medical Group
01.2019 - Current
Bookkeeping Administrative Assistant
Oklahoma City Ear Nose & Throat Clinic
01.2002 - 01.2019
Administration Assistant
Oklahoma City Ear Nose & Throat Clinic
02.1999 - 01.2019
Administrative Assistant, And Accounting - Medical Administrative Assistant
Wright Business School