Summary
Dynamic and dependable professional skilled in managing multiple priorities while maintaining a positive attitude and contributing to team success. Possesses a strong leadership background with proven expertise in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes that uphold high standards and align with organizational goals, fostering a collaborative environment. Recognized for a commitment to excellence and a readiness to embrace additional responsibilities to drive team achievements.
Overview
11
11
years of professional experience
Work History
Prior Authorization Specialist Remote
Sanford Medical Health
09.2023 - 08.2025
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Assisted healthcare providers with appeals for denied authorizations, including gathering additional information and documentation.
- Evaluated patient eligibility and benefits for requested procedures and medications.
- Contacted insurance companies to obtain necessary preauthorization's needed for upcoming tests and procedures.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Medical Office Specialist II
Centra Health
01.2018 - 01.2023
- Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
- Acquired insurance authorizations for procedures and tests ordered by attending physician.
- Collected information, verified insurance and collected co-payments for patients as part of check-in process.
- Scheduled appointments for patients via phone and in person.
- Assisted with referrals and prepared medical records for patients.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Received, recorded and filed medical payments by check, cash, and credit card.
- Used Cerner to schedule appointments for doctor visits and procedures.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
Administrator
Team Nurses
02.2015 - 01.2018
- Researched and developed administrative policies, procedures and guidelines to facilitate operations.
- Maintained positive working relationship with fellow staff and management.
- Organized client meetings to provide project updates.
- Oversaw quality control to identify inconsistencies and malfunctions.
- Audited company's legal documents to verify compliant policies and procedures.
- Coordinated communications, financial processing, registration, recordkeeping, and other administrative functions.
- Coordinated individual duties after careful evaluation of each employee's skill level and knowledge.
- Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
Education
High School Diploma -
06.2004
- Completed CNA Course
- BLS Certificate 2025
- CPR/AED Certified 2024
- Medication Certification 2024
Skills
- EMR Updating
- Educating Patients
- Verifying Insurance
- Patient Relations
- Payment Collection
- Schedule Coordination
- Customer Service
- Data Entry Software
- Payment Scheduling and Collection
- Documentation and Recordkeeping
- Insurance Authorizations
- Critical Thinking
- Computer Proficiency
- Documentation Review
- Referral Verification
- HIPAA Compliance
- CPT coding
- Knowledgeable in Epic
- Medical terminology knowledge
- Healthcare regulations
- Insurance verification
- ICD-10 coding
- Medical terminology
- Knowledgeable in Epic & Cerner
- Patient scheduling
Certification
- BLS Training - 2025
- TOVA Training - 2025
- AED/CPR Training - 2024
- Medication Training - 2024
Timeline
Prior Authorization Specialist Remote - Sanford Medical Health
09.2023 - 08.2025
Medical Office Specialist II - Centra Health
01.2018 - 01.2023
Administrator - Team Nurses
02.2015 - 01.2018
Rustburg High School - High School Diploma,
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