LaToya Williams
Beaumont,TX
Summary
Highly organized and detail-oriented Prior Authorization Coordinator with over 8 years of experience in mental health and behavioral health administration. Proven success in managing prior authorizations, insurance verification, and utilization review while ensuring timely patient access to care. Recognized for strong payer relations, accuracy in documentation, and collaborative communication with providers, patients, and insurance representatives. Adept at balancing a high case load in fast-paced environments while maintaining compliance with HIPAA, Medicare/Medicaid, and commercial payer regulations.
Overview
7
7
years of professional experience
Work History
Prior Authorization Coordinator
Alma Community Network
03.2023 - Current
- Process 40–60 prior authorization requests per day for outpatient therapy, psychiatric evaluations, psychological testing, and inpatient treatment.
- Verify benefits and eligibility for Medicaid, Medicare, and commercial plans, ensuring correct documentation and clinical criteria.
- Collaborate with clinicians and case managers to collect supporting documentation and expedite urgent requests.
- Utilize multiple payer portals (Optum, Magellan, Aetna, BCBS, Medicaid) to submit, track, and appeal authorization requests.
- Reduced average turnaround time for authorizations by 30% by developing a standardized documentation checklist.
- Achieved 95% first-submission approval rate by ensuring coding accuracy and alignment with payer requirements.
- Trained and mentored new hires on payer guidelines, workflows, and EHR navigation.
Utilization Review Coordinator
Outpatient Diagnostic Center
06.2020 - 03.2023
- Provided administrative support to psychiatrists, therapists, and case managers in a high-volume behavioral health setting.
- Scheduled patient appointments, verified insurance, and processed intake forms.
- Maintained accurate patient records and ensured compliance with HIPAA confidentiality standards.
- Assisted in preparing utilization review reports for insurance companies.
Insurance Verification Specialist
Advanced Cardiovascular Specialists
08.2018 - 06.2020
- Conducted insurance verification for 50+ daily patient appointments, confirming coverage, copays, deductibles, and out-of-network benefits.
- Communicated authorization requirements and financial responsibilities to patients prior to services.
- Assisted clinicians in collecting clinical notes and medical necessity documentation for authorization approval.
- Implemented a tracking system for pending authorizations that decreased lost revenue by 15%.
- Partnered with billing staff to resolve claim denials related to authorization issues.
Education
Diploma -
Central High School
Beaumont, TXSkills
- EHR Systems: Epic, Cerner, Athena, AdvancedMD, NextGen
- Payer Portals: Availity, NaviNet, Optum, Magellan, Aetna, BCBS
- Microsoft Office Suite (Word, Excel, Outlook, Teams)
- Google Workspace (Docs, Sheets, Drive)
- Strong Typing Speed & Data Entry Accuracy
- HIPAA compliance
- Insurance coverage verification
- Patient confidentiality
Timeline
Prior Authorization Coordinator
Alma Community Network
03.2023 - Current
Utilization Review Coordinator
Outpatient Diagnostic Center
06.2020 - 03.2023
Insurance Verification Specialist
Advanced Cardiovascular Specialists
08.2018 - 06.2020
Diploma -
Central High School
Core Competencies
- Prior Authorization Processing & Case Management
- Insurance Verification & Benefits Eligibility
- Knowledge of Behavioral & Mental Health Services
- CPT/ICD-10 Coding & Documentation Support
- EHR & Practice Management Systems (Epic, Cerner, Athena, AdvancedMD, etc.)
- Payer Portal Navigation (Medicare, Medicaid, Commercial)
- Compliance with HIPAA & Payer Guidelines
- Appeals & Denials Management
- Patient & Provider Communication
- Training & Mentorship of New Staff
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