Jennifer David
St Paul,MO
Summary
Proven Prior Authorization Specialist with a track record of enhancing workflow efficiency and patient satisfaction at Boonslick Medical Group. Expert in ICD-10 coding and adept at effective communication, I significantly reduced authorization turnaround times. My collaborative approach and attention to detail have consistently improved service delivery, achieving a high success rate in obtaining necessary patient authorizations.
Overview
18
18
years of professional experience
Work History
Prior Authorization Specialist
Boonslick Medical Group
07.2019 - 08.2024
- 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.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- 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.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- 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.
- Developed and maintained productive working relationships with healthcare providers.
- Advocated for patients by negotiating with insurance providers to cover necessary treatments not initially authorized.
Unit Secretary
Northwest Healthcare
03.2006 - 05.2015
- Assisted nursing staff with patient care, ensuring timely completion of tasks and improved patient satisfaction.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Managed incoming calls and directed to appropriate department.
- Maintained a clean, organized work environment for optimal efficiency in the delivery of patient care services.
- Supported hospital compliance efforts by adhering to privacy policies and HIPAA regulations when handling sensitive patient information.
- Maintained rapport with physicians, nurse,s and other healthcare personnel.
- Improved unit workflow by effectively prioritizing tasks and collaborating with team members to complete assignments in a timely manner.
- Coordinated communication between medical staff and patients'' families, keeping everyone informed on treatment plans and progress updates.
- Managed inventory levels of office supplies, ensuring adequate stock was available at all times for efficient unit operations.
- Demonstrated flexibility in adjusting work hours to meet fluctuating demands of the unit, ensuring coverage during both peak times and staff shortages.
- Maintained current and accurate medical records for patients.
- Transcribed doctors' medication orders, lab test requests, and care plans.
- Upheld a high standard of patient service by addressing concerns and resolving issues in a timely, empathetic manner.
- Streamlined unit operations by maintaining an organized filing system for easy access to patient information.
- Maintained clean and organized front desk, contributing to welcoming environment for patients and visitors.
- Performed various administrative tasks by filing, copying and faxing documents.
Education
No Degree - General
St Charles Community College
St Charles MOSkills
- Electronic Health Records Proficiency
- CPT coding knowledge
- Medical terminology knowledge
- Understanding of medical terms
- Professionalism and Ethics
- Process improvement strategies
- Workflow Management
- Understanding of insurance details
- Pharmacy benefit management
- Provider Relations
- Critical thinking abilities
- Multitasking
- Problem-Solving
- Telephone Etiquette
- Appointment Scheduling
- Time Management
- Attention to Detail
Timeline
Prior Authorization Specialist
Boonslick Medical Group
07.2019 - 08.2024
Unit Secretary
Northwest Healthcare
03.2006 - 05.2015
No Degree - General
St Charles Community College
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