Latoyya Haywood
Las Vegas,NV
Summary
Detail-oriented prior authorization specialist proudly offering several years' experience managing medical documents meticulously. Polished professional known for working closely with insurance companies to alleviate denied claims and obtain necessary prior approvals for services. Multitasks expertly in fast-paced environments. Dependable Prior Authorization Specialist with a career spent handling various administrative responsibilities in fast-paced settings. Bilingual individual dedicated to finding solutions to issues and obtaining prior authorization information for patients. Ready to tackle new challenges in an office-based environment.
Overview
7
7
years of professional experience
2
2
years of post-secondary education
Work History
Prior Authorization Specialist
Molina Healthcare-Part time Weekend Skeleton Crew
05.2023 - Current
- Coordinating cases for prior authorization reviews, ensuring compliance with organizational and regulatory requirements.
- Able to communicate clearly and professionally with members, providers, and internal departments.
- Verifying insurance coverage for services, submitting prior authorizations, requesting documentation, following up on documentation requests, processing orders for shipment and maintaining positive customer relations while adhering to company policies and procedures.
- Communicates identified payer trends such as denials for specific procedures, diagnosis codes, or other identified issues.
- Processed prior authorization requests for medical services and procedures efficiently.
- Reviewed clinical documentation for accuracy and completeness before submission.
- Coordinated with healthcare providers to gather necessary information for approvals.
- Communicated with patients regarding their authorization status and next steps.
- Maintained up-to-date knowledge of insurance policies and prior authorization requirements.
- Assisted team members in resolving complex authorization issues collaboratively.
- Documented interactions in the system to ensure compliance and traceability.
- Monitored workflow to maintain timely processing of authorization requests consistently.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Notified ordering providers of denied authorizations.
- Maintained accurate records of all authorization activities in the database system.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Maintained positive working relationship with fellow staff and management.
- Monitored changes in insurance policies and guidelines to ensure compliance with prior authorization processes.
Utilization Management Specialist
Prime Therapeutics LLC
05.2022 - Current
- Primarily responsible for utilizing patients' Electronic Health Records to examine insurance claims.
- Maintain meticulous records of medical costs, adjustments, copayments, and other billing details.
- Communicate with insurance carriers, update internal billing databases, electronically store patient records, file registration on forms, and analyze insurance claims.
- Detect coding errors for correct billing and verification of medical coverage.
- Assist patients in understanding their medical benefits and follow all regulations and coding procedures to allow for prompt payment of medical services.
- Analyze patient data to determine reimbursement eligibility.
- Examine payer policies, minimizing patient denials, maximizing reimbursement compensation on, and producing cost reports.
- Demonstrated knowledge of insurance billing relating to patient reimbursement.
- Evaluated medical necessity for prior authorizations and concurrent reviews.
- Implemented process improvements to enhance efficiency in authorization workflows.
- Assessed requests for out-of-network services to determine if they meet medical necessity criteria.
- Maintained accurate documentation of all utilization management activities.
- Performed concurrent reviews of inpatient admissions, ensuring appropriate level of care was provided.
- Reviewed claims for accuracy prior to submission for payment processing.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Documented all utilization review activities, findings, and decisions in patient records and databases.
- Liaised between patients, healthcare providers, and insurance companies to clarify coverage and authorize services.
- Collaborated with case managers to facilitate timely discharge planning and transition of care.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Coordinated discharge planning to ensure continuity of care post-hospitalization.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
Prior Authorization Specialist
Comprehensive Cancer Centers of Nevada
09.2020 - 04.2022
- Review, process and audit the medical necessity for each patient to have genetic, molecular and or genomic laboratory testing, and office visits.
- Submitted prior authorizations for each patient to have oncology drugs requested by their doctor (iron treatments, chemo, non-chemo etc.).
- Checking patient regimens and making sure each drug has an authorization obtained before their scheduled appointment.
- Checking insurance websites making sure regimens are on pathways and are preferred drugs for patient's insurance payer.
- Organizing cases by priority to be worked to make sure turnaround times have been met.
- Remote Position
- Processed prior authorization requests for medical services and procedures efficiently.
- Coordinated with pharmacy staff to ensure medications requiring prior authorization are processed correctly.
- Monitored changes in insurance policies and guidelines to ensure compliance with prior authorization processes.
- Maintained files for referral and insurance information, entering referrals into system.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Provided guidance to providers regarding the prior authorization process.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Notified ordering providers of denied authorizations.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
Medical Office Manager/ Billing Specialist/Authorization Specialist
Las Vegas Pan Relief Center
Henderson, USA
04.2019 - 09.2020
- Ensure good business practices for the organization while the clinicians focus on providing health care, fully engaged in the unique environment and clientele of the healthcare setting.
- Interactions with clinicians and complying with governmental regulations.
- Submission of authorizations for chiropractic services from insurance payers.
- Taking responsibility for all non-clinical aspects of the day-to-day operations.
- Responsible for financial performance of the revenue cycle.
- Supervision of patient scheduling, registration, financial counseling, medical records, billing and collection, data entry and cash posting, all while greeting patients and answering a high volume of incoming phone calls.
- Coordinating day-to-day operations of the practice.
- Promoting excellent customer service.
- Develop, implement, and maintain office policies and procedures.
- Maintain and manage all filing and organizational systems for the practice.
- Ensures patient satisfaction with troubleshooting when there is a complaint and developing process improvements to prevent recurrences.
- Ensure regulatory compliance with HIPAA, OSHA, labor laws, and other federal, state, and local regulations.
- Interviews, hires, and trains selected productive medical office team and conducts performance reviews.
- Coordinate staff meetings for administrative and clinical staff and coordinate logistics for internal and external meetings and conferences.
- Henderson, NV
Education
Bachelor of Science - Health Services Management
DeVry University
Las Vegas, NV 09.2024 - 04.2026
Medical Billing and Coding -
Brightwood College
Las Vegas, NVHigh School -
Locke High School
Los Angeles, CASkills
- Health insurance verification
- Prior authorization processing
- Electronic health records
- Medical billing procedures
- Customer service
- Authorizations
- Prior authorization process
- Retro-authorizations
- Precertification requirements
- Outpatient surgery coding
- Data entry
- HIPAA compliance
- Time management
- Attention to detail
- Personal accountability
- Payment collection
- Medicare expertise
References
Available upon request
Timeline
Bachelor of Science - Health Services Management
DeVry University
09.2024 - 04.2026
Prior Authorization Specialist
Molina Healthcare-Part time Weekend Skeleton Crew
05.2023 - Current
Utilization Management Specialist
Prime Therapeutics LLC
05.2022 - Current
Prior Authorization Specialist
Comprehensive Cancer Centers of Nevada
09.2020 - 04.2022
Medical Office Manager/ Billing Specialist/Authorization Specialist
Las Vegas Pan Relief Center
04.2019 - 09.2020
Medical Billing and Coding -
Brightwood College
High School -
Locke High School