Jessie Erickson
West Jordan
Summary
Dynamic Prior Authorization Specialist with a proven track record at Bariatric Medicine Institute, excelling in insurance verification and effective communication. Achieved high authorization success rates by demonstrating medical necessity and maintaining patient confidentiality. Skilled in claims processing and dedicated to delivering exceptional customer service while managing complex workflows efficiently.
Overview
14
14
years of professional experience
Work History
Prior Authorization Specialist
Bariatric Medicine Institute
11.2015 - 05.2025
- 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.
- Verified eligibility and compliance with authorization requirements for service providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- 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.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Increased approval rates for necessary medical procedures by providing detailed justifications and patient history during review process.
Center of Excellence MBSCR
Bariatric Medicine Institue
11.2015 - 05.2025
- Self-motivated, with a strong sense of personal responsibility.
- Entering PHI into the MBSAQIP data base.
- Yearly tests for the MBSAQIP certificate.
- Patient follow up, 30 days post surgery, 6 months and yearly there after to keep in compliance with the COE standards.
- Entering in yearly forms into the MBSAQIP data base .
- Entering initial surgical patients into the MBSAQIP data base as well as follow ups for readmissions, ER visits, and IV therapy.
Benefits Specialist
Bariatric Medicine Institute
11.2015 - 05.2025
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone and email.
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Verified patients medical and surgical benefits, prior to them having surgery.
- Handled single-case agreements for Bariatric Procedures and Gastric Pacemaker procedures.
Billing Specialist
Bariatric Medicine Institute
11.2015 - 05.2025
- Researched and resolved billing discrepancies to enable accurate billing.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Worked with multiple departments to check proper billing information.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
- Collaborated with the collections team to recover overdue payments from clients, maintaining cash flow and minimizing writeoffs.
- Reduced errors in financial records by conducting regular audits of billed accounts.
- Entered in all of our EOB's and checks into our billing system, AdvancedMD.
- Processed payments both from patients and insurance companies.
- Utilized multiple insurance websites to view and enter claims, and review remittance's, such as Availity, Optum, Zelis, CareAffiliate, etc...
Receptionist
Center of Orthopedic and Rehabilitation Excellence
08.2011 - 10.2015
- Greeted incoming visitors and customers professionally and provided friendly, knowledgeable assistance.
- Confirmed appointments, communicated with clients, and updated client records.
- Answered phone promptly and directed incoming calls to correct offices.
- Kept reception area clean and neat to give visitors positive first impression.
- Resolved customer problems and complaints.
- Handled cash transactions and maintained sales and payments records accurately.
- Handled medical records and patient charts.
- Streamlined front desk operations for increased efficiency by effectively managing phone calls, emails, and walk-in clients.
- Responded to inquiries from callers seeking information.
- Supported office efficiency by performing clerical tasks such as data entry, photocopying, scanning, and faxing documents.
- Demonstrated strong multitasking abilities while managing numerous tasks simultaneously under tight deadlines.
Education
Taylorsville High School
Taylorsville, UT06-2011
Skills
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Insurance verification
- Authorizations
- Effective communication skills
- Patient referrals
- Data entry
- Electronic health records proficiency
- Medical terminology knowledge
- Benefit coverage
- Medical office procedures
- Professionalism and ethics
- Billing procedures
- Insurance procedures
- Workflow management
- Retro-authorizations
- Patient confidentiality compliance
- Records maintenance
- Patient scheduling
- Claims processing experience
- Utilization review experience
- Medical coding
- Proficiency in [software]
- ICD-10 coding
- HIPAA compliance
- CPT coding
- Precertification requirements
- Outpatient surgery coding
- Telephone etiquette
- Appointment scheduling
- Documentation and paperwork
- Teamwork and collaboration
- Customer service
- Multitasking Abilities
- Computer proficiency
- Goal setting
Timeline
Prior Authorization Specialist
Bariatric Medicine Institute
11.2015 - 05.2025
Center of Excellence MBSCR
Bariatric Medicine Institue
11.2015 - 05.2025
Benefits Specialist
Bariatric Medicine Institute
11.2015 - 05.2025
Billing Specialist
Bariatric Medicine Institute
11.2015 - 05.2025
Receptionist
Center of Orthopedic and Rehabilitation Excellence
08.2011 - 10.2015
Taylorsville High School
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