Kimberly Watson
Spring
Summary
Amiable Prior Authorization Representative with 8 years of connecting patients and healthcare providers to vital resources. Dedicated to executing on prescribed medical funding guidelines and policies. Maintains compassionate and sympathetic relations with consumers. Adept at balancing business interests with human-centric service models. Detailed Customer Service Reps committed to never letting vital requests or documents go unprocessed. Diligent tracker of patient outcomes and caretaker feedback. Incorporates empathetic communications with professional best practices to satisfy plan members and business goals alike. Organized professional knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in medical offices, communicating effectively orally and through writing and developing prior authorization workflows.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Cigna
09.2024 - Current
- 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.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
Prior Authorization Representative
Prime Therapeutics LLC
09.2021 - 09.2024
- Verified eligibility and compliance with authorization requirements for service providers.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
- Processed new medication and refill requests for authorization.
- Communicated pertinent information to client's prescribing provider to facilitate quality service.
- Improved patient satisfaction by efficiently processing prior authorization requests and ensuring timely responses.
- Reduced claim denials by thoroughly reviewing and analyzing medical necessity documentation before submitting for approval, ensuring all criteria were met.
- Streamlined workflow for faster approval turnaround times, handling high volume of insurance verification tasks.
- Collaborated with healthcare providers to expedite the process of obtaining necessary medical documentation for approvals.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
Tax Preparer
Intuit
01.2021 - 04.2023
- Advised clients to comply with IRS regulations and meet state and federal tax obligations.
- Finalized and processed paperwork with local, state and federal government authorities.
- Supplied detailed tax documentation needed to submit accurate corporate and individual returns.
- Prepared estimated and deferred tax calculations on monthly basis to forecast cash flows.
- Used tax form instructions and tables to complete tax forms.
- Interviewed clients to obtain additional information on taxable income and deductible expenses and allowances.
- Maintained high levels of confidentiality when dealing with sensitive client information, fostering trust and loyalty among clients.
- Analyzed financial records to verify accuracy of tax returns.
Customer Service Sales Specialist
Asurion Insurance Services
04.2010 - 02.2013
- Delivered superior customer service to retain existing customers and attract future customers.
- Informed customers of sales and promotions to build customer base, boost traffic and increase customer loyalty.
- Determined customer needs and interests to recommend cell phone insurance coverage to customers.
Pharmacy Technician
Walgreens
01.2008 - 03.2010
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Promoted patient confidentiality by adhering to HIPAA regulations when handling personal information during transactions.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Counted and labeled prescriptions with correct item and quantity.
- Assisted in maintaining a clean and organized work environment, ensuring compliance with safety regulations.
Education
Associate of Science - Cyber Security
Lonestar Community College
06.2025
No Degree - Pharmacy Technician Certification
Living Word Pharmacy Technician School LLc
09.2024
Certificate - Real Estate
Champion School of Realtor
03.2022
Associate of Arts - Hospitality Administration And Management
Houston Community College
07.2013
Skills
- Liability Determinations
- Rules of Evidence
- Claim Validity Determination
- Property Adjusting
- Insurance Policy Coverage Knowledge
- Claims Evaluations
- Property Claims
- Healthcare Industry Knowledge
- Retro-Authorizations
- Patient Scheduling
- Insurance Verification
- Client Service
- Follow-up skills
Certification
State Farm Auto Certification
State Far Policy Certification
Notary Public license
Education
Houston, TX,Houston, TX,Houston, TX
Contact
Spring, United States 77379
Timeline
Prior Authorization Specialist
Cigna
09.2024 - Current
Prior Authorization Representative
Prime Therapeutics LLC
09.2021 - 09.2024
Tax Preparer
Intuit
01.2021 - 04.2023
Customer Service Sales Specialist
Asurion Insurance Services
04.2010 - 02.2013
Pharmacy Technician
Walgreens
01.2008 - 03.2010
No Degree - Pharmacy Technician Certification
Living Word Pharmacy Technician School LLc
Certificate - Real Estate
Champion School of Realtor
Associate of Arts - Hospitality Administration And Management
Houston Community College
Associate of Science - Cyber Security
Lonestar Community College
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