Jennifer Jones
Crescent ,OK
Summary
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives by phone to gain preapproval for procedures and testing. Detail-oriented performer with over 20 years of medical experience. Considered team player with exemplary multitasking skills. As well as customer service skills from scheduling patients, communicating benefits, procedure instructions, procedure results, patient registration, check in/out and answering any patient questions.
Overview
22
22
years of professional experience
Work History
Prior Authorization Representative Work From Home
Mercy Hospital Oklahoma City
Oklahoma City, OK
11.2021 - Current
- Verified eligibility and compliance with authorization requirements for service providers.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Initiated process improvement through collaboration with peers, inter-company departments and leadership to exceed goals.
Patient Access Representative
Mercy Hospital Oklahoma City
Oklahoma City, OK
07.2021 - 10.2022
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
- Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
- Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
- Explained estimated cost for medical treatments and answered patient questions to promote good understanding of proposed services.
Self Employed
The Coffee Barn
Crescent , OK
09.2015 - 05.2021
- Complied with health and safety codes
- Resolved customer concerns with positive approach and constructive strategies.
- Established merchandising, sales and profit objectives to drive business success.
- Cleaned and maintained kitchen equipment and oven.
- Managed inventory, expenses and other operational processes.
- Served customers daily with professional and effective customer service.
- Ran and maintained all equipment
Surgery Scheduling Coordinator
Arun Sachdev, MD
Oklahoma City, OK
07.2007 - 08.2015
- Answered telephone calls to offer office information, answer questions and direct calls to staff.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Surgery precertifications
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Obtained payments from patients and scanned identification and insurance cards.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Contacted hospitals to confirm patients medical histories and prevent inaccurate diagnoses and treatments.
- Accurately completed insurance and Medicaid billing and OASIS documentation for patient visits.
- Scheduled appointments with applicants to gather information and explain benefits processes.
Medical Office Manager
Imad Zantout, MD
Oklahoma City, OK
06.2001 - 06.2007
- Communicated effectively with staff members, physicians and patients, employing active listening and interpersonal skills.
- Provided proper scheduling of patients, ensuring timely and effective allocation of resources and calendars.
- Assessed processes and procedures, complying with OSHA and HIPAA regulations.
- Assisted with regulatory issues such as compliance.
- Scheduling
- Precertifications medical/prescription
Education
High School Diploma -
Crescent Public Schools
Crescent 05.1992
Skills
- Patient Registration
- Registration Paperwork
- Healthcare Terminology
- Insurance Information Oversight
- Patient Insurance Authorizations
- Registration Processes
- Referral Tracking
- Problem Resolution
- Specialist Procedures
- Health Insurance Plan Knowledge
- Client Service
- Outpatient Procedures
- Clinical Messaging
- Electronic Medical Records Management
- Customer Satisfaction
- Client Relationships
- Account Updates
- Office Operations
- Patient Account Reviews
- Office Supplies and Inventory
- Patient Admission
- Compassionate Communication
- Benefits Verifications
- Reminder Calls
- Precertification Processing
- Demographics Information
- Medical Records Requests
Timeline
Prior Authorization Representative Work From Home
Mercy Hospital Oklahoma City
11.2021 - Current
Patient Access Representative
Mercy Hospital Oklahoma City
07.2021 - 10.2022
Self Employed
The Coffee Barn
09.2015 - 05.2021
Surgery Scheduling Coordinator
Arun Sachdev, MD
07.2007 - 08.2015
Medical Office Manager
Imad Zantout, MD
06.2001 - 06.2007
High School Diploma -
Crescent Public Schools
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