LaShawna Butler
Martinez,GA
Summary
Detail-oriented Authorization Specialist with a proven track record in claims management and prior authorization processing. Expertise in medical terminology and insurance verification, committed to optimizing workflows and enhancing operational efficiency.
Overview
16
16
years of professional experience
Work History
Authorization Specialist
Wellstar MCG
09.2024 - Current
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Verified eligibility and compliance with authorization requirements for service providers.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
Medical Billing Supervisor
CDR Maguire
02.2021 - 05.2024
- Supervised billing team, ensuring adherence to compliance and industry regulations.
- Implemented process improvements, enhancing accuracy in claim submissions and reducing denial rates.
- Trained staff on billing software and best practices, fostering a culture of continuous learning.
- Reviewed complex claims for accuracy, resolving discrepancies to expedite reimbursement processes.
- Analyzed billing reports to identify trends, recommending strategies for operational efficiency.
- Conducted performance evaluations, providing feedback and development plans for team members.
- Led cross-functional meetings to address challenges and streamline medical billing operations effectively.
- Submitted electronic and paper claims to insurance companies, Medicare and Medicaid to collect medical payments.
- Analyzed medical records to satisfy insurance company mandates.
- Increased revenue by identifying underpayments and errors, ensuring proper reimbursement from insurance companies.
Surgery Scheduler
Vein Guy's
08.2020 - 02.2021
- Coordinated patient appointments, ensuring alignment with physician schedules and operational workflows.
- Managed pre-operative requirements, confirming insurance coverage and obtaining necessary authorizations.
- Optimized scheduling processes to enhance patient flow and minimize wait times for surgical procedures.
- Developed training materials for new staff on scheduling protocols and software usage.
- Educated patients on pre-surgery requirements, such as fasting protocols or medication adjustments, resulting in fewer complications on the day of the procedure.
- Arranged pre-operative and post-operative appointments for surgical patients.
- Verified insurance coverage and obtained pre-authorizations.
- Resolved scheduling conflicts to maintain high-quality patient services.
Medical Assistant
Augusta Family Allergy
02.2010 - 08.2020
- Administered allergy testing procedures, ensuring patient comfort and adherence to protocols.
- Assisted in developing patient treatment plans, enhancing overall care effectiveness.
- Managed patient records using electronic health record (EHR) systems to maintain accuracy and confidentiality.
- Coordinated patient appointments, optimizing scheduling efficiency and reducing wait times.
- Trained new staff on clinical procedures and office protocols, fostering a collaborative team environment.
- Educated patients on allergy management strategies, increasing compliance with treatment regimens.
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Obtained client medical history, medication information, symptoms, and allergies.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.
- Administered medications and injections as prescribed, adhering strictly to protocols for patient safety.
Education
Bachelor of Arts - Healthcare Administration
Columbia Southern University
Orange Beach, ALCertificate of Technical Studies - Medical Assisting
Augusta Technical College
Augusta, GA01-2010
High School Diploma -
Aiken Academy
Aiken, SC06-1999
Skills
- Claims management
- Medical terminology expertise
- Insurance verification
- Data entry proficiency
- Prior authorization processing
- Medical coding
- Appointment scheduling
- Microsoft office
- Medicaid
- Income verification
- Authorizations
- Attention to detail
- Adaptability and flexibility
- Critical thinking
- Account reconciliation
Timeline
Authorization Specialist
Wellstar MCG
09.2024 - Current
Medical Billing Supervisor
CDR Maguire
02.2021 - 05.2024
Surgery Scheduler
Vein Guy's
08.2020 - 02.2021
Medical Assistant
Augusta Family Allergy
02.2010 - 08.2020
Bachelor of Arts - Healthcare Administration
Columbia Southern University
Certificate of Technical Studies - Medical Assisting
Augusta Technical College
High School Diploma -
Aiken Academy