Lauren Ganucheau
Scottsdale,AZ
Summary
Detail-oriented healthcare professional with expertise in prior authorization, insurance verification, and healthcare operations. Skilled in managing high-volume communications with insurance providers, securing service approvals, and ensuring regulatory compliance. Adept at streamlining processes, reducing authorization delays, and collaborating with cross-functional teams to enhance patient care. Proficient in Salesforce, payer portals, and medical record systems, with a strong commitment to accuracy, efficiency, and patient advocacy.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Pre-Service Specialist, Prior Authorization Department
MedHealth Partners
Scottsdale, AZ
03.2021 - Current
- Manage prior authorization processes by verifying patient eligibility, benefits, and medical necessity with insurance providers
- Facilitate communication between registered nurses, physicians, and payers to expedite service approvals for critical air ambulance transport
- Submit and track 55 authorization requests per month, ensuring timely and accurate processing
- Analyze denial rationales and provide detailed appeals guidance to the legal team, contributing to a 30% increase in approval rates since 2021
- Attach and organize incoming mail, faxes, and voicemails in Salesforce to maintain accurate patient records
- Utilize payer portals, including Availity, NaviNet, OneHealthPort, GAMMIS, Passport, Capario, and UMR, to verify benefits and authorization requirements
Insurance Investigator (Contractor)
RemX/McKesson
Tempe, AZ
12.2019 - 02.2021
- Conducted insurance verifications and liaised with payers to confirm patient eligibility and benefits
- Assisted in streamlining the prior authorization process, reducing delays in medical service approvals
- Utilized Salesforce and payer portals to document case updates and track approvals
Administrative Specialist (Contractor)
Apollo Healthcare & Diagnostics
Tempe, AZ
06.2020 - 09.2020
- Verified patient benefits and demographics to ensure accurate insurance processing
- Scheduled and confirmed patient appointments while managing front-office administrative tasks
Education
Diploma -
Archbishop Chapelle High School
Skills
- Prior authorization
- Insurance verification
- Benefit determination
- Documentation management
- Regulatory compliance
- Customer service
- Critical thinking
- Attention to detail
- Effective communication
- Team collaboration
- Verbal and written communication
- Healthcare systems navigation
- Phone and email etiquette
- HIPAA compliance
- Records maintenance
- Eligibility determination
- Data entry
- Patient identity verification
- Appointment scheduling
- Multitasking and organization
- Medical records verification
Certification
HIPAA Compliance Training (Completed)
Accomplishments
- Contributed to a 30% increase in approval rates since 2021 by refining prior authorization workflows and improving communication with insurance providers.
- Processed an average of 55 authorization submissions per month, ensuring accuracy and compliance with payer requirements.
- Provided detailed denial rationales and appeals processes, supporting the legal team in overturning denials and securing patient care approvals.
Technology And Software Proficiency
• Healthcare & Insurance Systems: Salesforce, Availity, NaviNet,
OneHealthPort, GAMMIS, Passport, Capario, UMR
• Communication & Productivity Tools: Microsoft Teams, Outlook, Word,
OneNote, Excel, Zoom
Timeline
Pre-Service Specialist, Prior Authorization Department
MedHealth Partners
03.2021 - Current
Administrative Specialist (Contractor)
Apollo Healthcare & Diagnostics
06.2020 - 09.2020
Insurance Investigator (Contractor)
RemX/McKesson
12.2019 - 02.2021
Diploma -
Archbishop Chapelle High School
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