JENNIFER HEINLEIN

I have worked within Mercy Health for over 20 years. I have made internal lateral moves to take me to the current professional level I am currently at. I have worked as a Patient Service Specialist/Prior Authorization Specialist for 9 years. Our physician group has expanded from 23 to 43 cardiologists during my tenure in this position. I am also responsible for training for this position as well.

I effectively communicate changes or trends in insurance policies to all 18 offices in our group. I obtain cardiac procedure and testing prior authorizations for all of our physicians in 6 different hospitals within a designated time frame. Contact with both physicians and nurses at insurance companies to give clinical information over the phone to speed up the authorization process. Trained in Epic System and Microsoft Office. Self starter and extremely organized, working remote for several years.

• Communicated with people from various cultures and backgrounds on application process.
• Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
• Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
• Tracked referral submission during facilitation of prior authorization issuance.
• Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
• Continually updated knowledge on industry developments, ensuring adherence to best practices and relevant regulatory changes impacting the prior authorization process.
• Fielded telephone inquiries on authorization details from plan members and medical staff.
• Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
• Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.

Sole scheduler for busy Cardiology practice. Coordinated surgical procedures and pre-operative testing. Organized schedules for each surgeon.

Busy Cardiology office working front desk checking in and out along with answering multi-line phones and messages on the board. Working closely with the practice manager to build weekly and monthly physician schedules.

Worked front desk of main hospital and emergency room. Registering patients for procedures, testing and to be seen by ER physicians. I worked the last two years at the front desk of the surgery center of the hospital registering patients for surgical procedures.