Justina Duncan
Radford,VA
Summary
Proven Clinical Insurance Specialist with a track record at US Oncology/Mckesson, adept in navigating complex authorization processes for oncology treatments, ensuring timely patient care. Demonstrates expertise in J codes and exceptional organizational skills, effectively managing high-stakes, high-volume workloads with precision. Achieved significant improvements in insurance authorization efficiency, supporting both revenue cycle and patient access.
Overview
14
14
years of professional experience
Work History
Clinical Insurance Specialist / Medical Assistant
US Oncology/ Mckesson
02.2011 - Current
Assess time sensitive Referral Work Queue to obtain highly complex authorizations including OP chemotherapy and IP if needed related to oncology treatment plans.
Manage high volume life altering, high cost treatment within a short time frame. Expected treatment 1-3 days. Interpret medical records to determine initial and disease progression to prove medical necessity for ordered services and complete on-line clinical requests for advanced authorizations.
Successfully work with payors via telephone or fax.
Monitor the status of prior authorization request, follow up on pending cases and initiate follow up on pending cases, if necessary, to ensure timely approvals.
Collaborate with physicians regarding encounters that require escalation to peer-to peer review.
Notify physicians and prepare letter and documents to file appeals for denied services.
Work denied claims if requested.
Contact appropriate personnel if LOA is needed for out-of-network insurances.
Review laboratory panels for ESA's and iv iron treatments.
Work closely with physicians, nurses , pharmacist and financial counselors to ensure treatment plans meet criteria and will be covered by insurance.
Stay updated on changes and updates in insurance policies and authorization processes.
Maintain accurate and detailed records of insurance authorizations in 3 different software systems.
Obtain authorizations if needed for oral narcotics, chemotherapy and supportive drugs.
Manage daily emails for patient insurance changes to obtain new authorizations if needed.
Manage message queue to respond quickly to nurses and physicians.
Work insurance denials if requested.
Education
Certificate - Medical Assisting
Dominion College
Roanoke, VASkills
Knowledge of prior authorization process and its impact on practice's revenue cycle
Proficient use of J codes, CPT codes, and ICD codes
Excellent computer skills including Excel, Word, internet, Gen2, IDX and Fast Auth
Knowledge of organization policies and procedures
Skilled in exercising initiative, judgement discretion, decision-making and organizational skills to achieve business objectives
Ability to communicate effectively and professionally orally and in writing
Ability to multi-task and remain focused while managing a high volume, time sensitive workload
Identify and resolve problems with obtaining a prior authorization approval or denial
Accomplishments
I have 30 years experience in the medical field which includes chiropractics, OBGYN, dermatology and oncology.
I have used my skills from obtaining prior authorizations, assisting in office surgeries, collections, front office work and office management.
Timeline
Clinical Insurance Specialist / Medical Assistant
US Oncology/ Mckesson
02.2011 - Current
Certificate - Medical Assisting
Dominion College