Authorization Specialist
Emblem Health Insurance
2000 - 2008
- Processed pre-authorization requests for medical services, ensuring compliance with insurance policies.
- Collaborated with healthcare providers to obtain necessary documentation for authorizations.
- Reviewed and analyzed patient information to determine eligibility for benefits and services.
- Communicated effectively with members regarding status of authorization requests and next steps.
- Maintained accurate records in electronic systems to track authorization workflows and outcomes.
- Assisted in training new staff on authorization procedures and best practices for efficiency.
- Identified areas for process improvement, contributing to enhanced workflow efficiency within the team.
- Ensured timely resolution of authorization issues, minimizing delays in patient care services.
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Contributed to team goals by consistently meeting or exceeding individual productivity targets for processing authorization requests.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Assisted in training new team members on company policies and procedures for handling authorization requests.
- Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during the authorization process.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Demonstrated adaptability with changing insurance requirements, maintaining up-to-date knowledge through continuous education efforts.
- Prevented delays in care delivery by proactively identifying potential issues during the pre-authorization process and seeking clarification from providers when needed.
- Ensured prompt resolution of denied claims through comprehensive analysis of denial reasons and timely submission of necessary documentation for reconsideration or appeal.
- Enhanced departmental efficiency with thorough knowledge of insurance guidelines and medical terminology.
- Expedited claim processing by submitting complete and accurate information in accordance with payer requirements.
- Promoted positive customer experiences by addressing concerns or questions related to authorizations in a professional manner.
- Processed and certified documents for accuracy and compliance with government regulations.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
- Trained staff on current eligibility requirements and policies.
- Built relationships with diverse stakeholders to achieve successful program implementation.