Laura Southard
Louisville
Summary
Results-driven Prior Authorization Specialist with expertise in process improvement and insurance verification. Proven ability to streamline workflows, enhance efficiency, and ensure compliance, contributing to improved patient care and timely authorizations.
Detail-oriented professional with extensive experience in prior authorization and scheduling. Known for effective communication skills and teamwork, successfully managing complex cases and collaborating with healthcare providers to expedite authorization processes.
Overview
26
26
years of professional experience
Work History
Prior Authorization Specialist and Scheduler
Commonwealth Pain and Spine
Louisville, KY
11.2019 - Current
- Managed prior authorization processes for various pain management services.
- Collaborated with medical providers to gather necessary documentation for approvals.
- Ensured compliance with insurance requirements and guidelines during authorization requests.
- Streamlined workflows to enhance efficiency in processing authorizations.
Prior Authorization Specialist
UofL Health
Louisville, KY
07.2024 - 10.2024
- Reviewed and processed prior authorization requests for medical services, ensuring compliance with policies.
- Collaborated with healthcare providers to gather necessary documentation for authorization approvals.
- Analyzed complex cases to determine eligibility based on insurance guidelines and service requirements.
- Trained new team members on prior authorization workflows and best practices for efficiency.
- Developed process improvement initiatives to streamline authorization workflow, reducing turnaround time.
- Coordinated with insurance companies to resolve discrepancies and expedite approval processes effectively.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
Prior Authorization Representative
Commonwealth Pain Associates
Louisville
01.2000 - 11.2019
- Processed prior authorization requests to ensure timely patient care and compliance with insurance policies.
- Collaborated with healthcare providers to gather necessary documentation for approval submissions.
- Reviewed medical records to assess eligibility and appropriateness of treatment plans for authorizations.
- Streamlined communication between patients, providers, and insurance companies to resolve authorization issues efficiently.
- Trained new staff on prior authorization procedures and best practices for documentation accuracy.
- Implemented process improvements that reduced turnaround time for authorization approvals across teams.
- Monitored ongoing changes in insurance regulations to maintain compliance within authorization processes.
- Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Education
High School Diploma -
Atherton High School
Lousville,Ky05-1995
No Degree - Medical Coding
Lincoln College of Technology
Skills
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Insurance verification
- Authorizations
- Effective communication skills
- Patient referrals
- Data entry
- Electronic health records proficiency
- Medical terminology knowledge
- Physician order verification
- Benefit coverage
- Medical office procedures
- Professionalism and ethics
- Process improvement strategies
- Insurance procedures
- Workflow management
- Retro-authorizations
- Patient confidentiality compliance
- Patient scheduling
- Performance metrics analysis
- Medical coding
- Critical thinking
- HIPAA compliance
- ICD-10 coding
- CPT coding
- Practitioner order verification
- Precertification requirements
- Multitasking
- Telephone etiquette
- Appointment scheduling
- Teamwork
- Teamwork and collaboration
- Customer service
- Time management
- Attention to detail
- Multitasking ability
- Problem-solving abilities
- Multitasking Abilities
- Reliability
- Excellent communication
- Organizational skills
Accomplishments
- Supervised team of 5 staff members.
- Used Microsoft Excel to develop inventory tracking spreadsheets.
Languages
English
Full Professional
Timeline
Prior Authorization Specialist
UofL Health
07.2024 - 10.2024
Prior Authorization Specialist and Scheduler
Commonwealth Pain and Spine
11.2019 - Current
Prior Authorization Representative
Commonwealth Pain Associates
01.2000 - 11.2019
No Degree - Medical Coding
Lincoln College of Technology
High School Diploma -
Atherton High School