Kristina Pratt
Jonesboro,AR
Summary
Proven track record in enhancing patient and provider experiences at St. Bernard's Physician Clinics through expert insurance verification and critical thinking. Increased compliance by 20% through meticulous claim research and effective communication, demonstrating strong organizational abilities and a commitment to excellence in healthcare administration. Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 10 years of managing documentation. Considered team player with exemplary multitasking skills.
Overview
25
25
years of professional experience
Work History
Prior Authorization Specialist
St. Bernard's Physician Clinics
03.2019 - Current
- Verified eligibility and compliance with authorization requirements for service providers.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Tracked referral submission during facilitation of prior authorization issuance.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Developed and maintained productive working relationships with healthcare providers.
Home Health Nurse
Unity Home Health
04.2015 - 03.2019
- Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
- Determined and addresses individual home care needs by completing detailed assessments and reviewing documentation.
- Provided physical assessments, medication, and chronic disease management to home health patients.
- Administered different therapies and medications in line with physician orders and treatment plan.
- Educated patients and families on disease processes, medications and treatments.
- Coordinated with other healthcare team members to support patient needs.
- Assessed patients' health status and developed individualized care plans to suit needs.
- Documented patient vitals, behaviors and conditions to communicate concerns to supervising nurse.
- Administered medications and treatments as prescribed by physicians.
- Monitored vital signs, developed and implemented care plans, and documented patient progress.
- Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
House Mother
Self
06.2012 - 04.2015
- Stay at home mother
Float Pool Nurse
WRMC
01.2010 - 06.2012
- Administered medications and treatments as prescribed by physicians.
- Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.
- Implemented care plans for patient treatment after assessing physician medical regimens.
- Worked with healthcare team to develop new dialysis treatment flow sheet and other log forms, improving clinical documentation and accountability.
- Monitored patient reactions after administering medications and IV therapies.
- Evaluated patient histories, complaints, and current symptoms.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
Medical Biller
Brighter Futures
01.2006 - 08.2008
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Delivered timely and accurate charge submissions.
- Adhered to established standards to safeguard patients' health information.
Administrative Assistant
Daysprings
01.2004 - 12.2006
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Maintained inventory of office supplies and placed orders.
- Supported company leaders by managing budgets, scheduling appointments and organizing itinerary.
- Opened and properly distributed incoming mail to promote quicker response to client inquiries.
- Managed filing system, entered data and completed other clerical tasks.
- Managed paper and electronic filing systems by routing various documents, taking messages and managing incoming and outgoing mail.
Cashier Assistant/Sales Associate
Puff's $12 Zoo
07.2002 - 12.2003
- Retrieved items for customers and verified prices.
- Answered questions about store policies and addressed customer concerns.
- Helped customers complete purchases, locate items, and join reward programs.
- Packed customer orders into boxes and bags, transferring to shopping cart.
- Removed trash, swept, and mopped floors for professional appearance.
- Cleaned and sanitized cashier workstation and scanning area.
- Worked with other associates to support cashiers and management needs.
- Monitored store for suspicious activity and reported security concerns for prompt action.
- Replenished shelves regularly to meet customer demand and maximise sales.
- Worked with floor team and managers to meet wide range of customer needs.
- Reconciled cash drawer at start and end of each shift, accounting for errors, and resolving discrepancies.
- Set up new sales displays each week with fresh merchandise.
Patient Service Representative
Harris Hospital
07.1999 - 06.2002
- Took copayments and compiled daily financial records.
- Balanced deposits and credit card payments each day.
- Used [Software] to schedule appointments.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Assisted patients in filling out check-in and payment paperwork.
- Verified insurance eligibility and coverage for patients.
- Entered patient demographic and insurance data into electronic medical record system.
- Managed patient registration process, confirming data accuracy and completeness.
Education
Associate of Science - Nursing
ASU Newport
Newport12.2012
Associate of Arts - General Studies
ASU Newport
Newport05.2002
Skills
- Claim research
- Insurance Verification
- Critical thinking abilities
- Billing Procedures
- Medicare and Medicaid knowledge
- Understanding of insurance details
- Authorizations
- Retro-Authorizations
- Effective communication skills
- Patient Referrals
- Insurance procedures
- Patient Scheduling
- Data Entry
- Product restocking
- Drawer balancing
- Customer Service
- Product Recommendations
- ID Verification
- Cash Handling
- Customer Assistance
- Organizational abilities
Timeline
Prior Authorization Specialist
St. Bernard's Physician Clinics
03.2019 - Current
Home Health Nurse
Unity Home Health
04.2015 - 03.2019
House Mother
Self
06.2012 - 04.2015
Float Pool Nurse
WRMC
01.2010 - 06.2012
Medical Biller
Brighter Futures
01.2006 - 08.2008
Administrative Assistant
Daysprings
01.2004 - 12.2006
Cashier Assistant/Sales Associate
Puff's $12 Zoo
07.2002 - 12.2003
Patient Service Representative
Harris Hospital
07.1999 - 06.2002
Associate of Science - Nursing
ASU Newport
Associate of Arts - General Studies
ASU Newport
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