Kristine Andersen
Riverton,UT
Summary
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for services provided by Homecare and hospice services. Detail-oriented performer with over 15 years of managing documentation. Considered team player with exemplary multitasking skills, self starter and out of the box thinker to get tasks done.
Showing compassion to patients when they called with any issues and making them feel at ease.
I would like to use what I have learned to benefit your company.
Overview
15
15
years of professional experience
Work History
Prior Authorization Representative - Homecare/Hospice
Intermountain Health Homecare And Hospice
2017.09 - Current
- Contacted insurance companies to obtain prior authorization for homecare and hospice through web portals or via email.
- Verified eligibility of patients insurance prior to submitting authorization request.
- Fielded telephone inquiries on authorization details from plan members and clinicians as questions arose.
- Sent emails to clinicians and billing, detailing reasons for denial and possible appeal measures.
- Worked with referral sources to obtain additional pertinent information to submit for authorization.
- Obtained and logged accurate patient authorization in EMR system.
- Maintained patient confidentiality and safeguarded medical records according to HIPPA guidelines
- Responded to inquiries from insurance companies regarding prior authorization requests.
- Keeping weekly track of authorization approved vs. what is being used by clinicians and requesting additional visits as needed.
- Helping train and answer questions by other team members as needed
- Helping audit charts for accuracy.
- Answering phone and helping answer questions or directing to department/ person who is better informed with the answer
- Special projects as assigned.
Office Coordinator / Biller
Rocky Mountain Homecare And Hospice
2009.02 - 2017.09
- Worked collaboratively with office staff to maintain smooth operations and team readiness for unexpected demands.
- Maintained office supplies inventory by checking stock and ordering new supplies.
- Filed medical information accurately in patient files per date of services.
- Managed office communication between clinicians and therapists.
- Collecting visit documentation from clinicals and therapists to build plan of cares for MD signatures.
- Sending MD orders for signatures and following up with MD offices if orders not back in timely manner.
- Efficiently supervised filing, sorting and handling incoming and outgoing mail.
- Answered and managed incoming and outgoing calls while recording accurate messages for distribution to office staff.
- Delegated tasks to clinicians to get documentation in timely manner.
- Requested authorization to insurance companies for visits as ordered by clinician and therapist.
- Keeping track of visits vs. authorization and requesting additional auth to cover visits as ordered.
- Helping billers with data entry for Medicare payment of raps and finials as needed.
- Attending weekly IDT meetings, taking notes for billing team regarding patients 60 day recerts, hospitalization and discharges.
- Helping organize Nurses, Home health aid recognition week and activities.
- Organized company meetings and scheduling for 20 clinicians and therapists.
- Maintained computer and physical filing systems.
- Participated in workshops and in-service meetings to enhance personal growth and professional development.
Education
High School Diploma -
Kearns High School
Kearns, UT06.1982
Skills
- Referral acceptance
- HIPPA guidelines
- Greeting patients via phone call to welcome them to our Home health agency / Problem resolution
- Medical Terminology
- Organizational skills
- Patient Scheduling
- Software Applications/ EMR systems
- Answering phones/ Call Transfers
- Self starter
- Office Supplies and Inventory
- Positive can do attitude
Timeline
Prior Authorization Representative - Homecare/Hospice
Intermountain Health Homecare And Hospice
2017.09 - Current
Office Coordinator / Biller
Rocky Mountain Homecare And Hospice
2009.02 - 2017.09
High School Diploma -
Kearns High School
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