Lakisha McCall
Summary
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
12
12
years of professional experience
Work History
Prior Authorization Specialist
Radiology Affiliates Of Central New Jersey
06.2018 - Current
- Input all patient data regarding claims and prior authorizations into system accurately.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- 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.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched denied claims and contacted insurance companies to resolve these issues.
Surgical Scheduler
Rothman Institute
09.2017 - 06.2018
- Arranged pre-operative and post-operative appointments for surgical patients.
- Verified insurance coverage and obtained pre-authorizations.
- Educated patients about surgeries and provided treatment plan documentation.
- Collated pre-operative lab and imaging results to facilitate surgery planning.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Obtained pre-authorizations and pre-certifications ahead of scheduled surgeries.
- Updated patient records to reflect upcoming surgeries and medical histories.
- Expertly managed planning, scheduling, and coordination of outpatient procedures.
Medical Biller and Coder
Trenton Orthopedic Group P.A.
02.2012 - 09.2017
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Utilized active listening, interpersonal, and telephone etiquette skills when communicating with others.
- Verified signatures and checked medical charts for accuracy and completion.
Education
High School Diploma -
Hightstown High School
Hightstown, NJ06.1995
Skills
- Understanding of Medical Terms
- Retro-Authorizations
- Patient Scheduling
- Benefit Coverage
- Understanding of Insurance Details
- Knowledgeable in Ramsoft, Athena, Intergy
- Medical Terminology
- Patient Referrals
- Effective Communication Skills
- Data Entry
Timeline
Prior Authorization Specialist
Radiology Affiliates Of Central New Jersey
06.2018 - Current
Surgical Scheduler
Rothman Institute
09.2017 - 06.2018
Medical Biller and Coder
Trenton Orthopedic Group P.A.
02.2012 - 09.2017
High School Diploma -
Hightstown High School
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