Hi, I’m
LAUREN SENICO
PRIOR AUTHORIZATION SPECIALIST
Cape May,NJ
Summary
Reliable Prior Authorization Specialist with over 13 years of experience working in fast-paced, pharmacy and diagnostic imaging clinical environments. Bilingual professional with skill in prior authorization for patients, finding solutions to issues and tackling work tasks in busy office.Professional in healthcare administration with strong background in managing authorization processes. Adept at ensuring compliance, streamlining workflows, and mitigating risks. Consistent track record of fostering team collaboration and achieving results in dynamic environments. Skilled in navigating complex systems, prioritizing tasks, and maintaining high standards of accuracy and efficiency.
Overview
13
years of professional experience
8
years of post-secondary education
1
Certification
Work History
COOPER UNIVERSITY HEALTH CARE REGIONAL
Prior Authorization Specialist
04.2024 - Current
Job overview
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Analyzed trends in denied requests to identify opportunities for process improvement and training.
- Continually updated knowledge on industry developments, ensuring adherence to best practices and relevant regulatory changes impacting the prior authorization process.
- Improved provider satisfaction with timely communications regarding authorization status updates.
- Collaborated with insurance companies to clarify coverage details and expedite review of complex cases.
- Advocated for patients by negotiating with insurance providers to cover necessary treatments not initially authorized.
- Identified trends in denials through data analysis, adapting strategies accordingly for improved success rates in obtaining approvals.
- Fostered positive relationships with healthcare providers by ensuring transparent communication throughout authorization process.
- Tracked referral submission during facilitation of prior authorization issuance.
- Improved patient outcomes by expediting authorization process for urgent and life-saving treatments.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Increased approval rates for necessary medical procedures by providing detailed justifications and patient history during review process.
- Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
Capsule Pharmacy
Prior Authorization Specialist
03.2023 - 04.2024
Job overview
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Analyzed trends in denied requests to identify opportunities for process improvement and training.
- Continually updated knowledge on industry developments, ensuring adherence to best practices and relevant regulatory changes impacting the prior authorization process.
- Improved provider satisfaction with timely communications regarding authorization status updates.
- Identified trends in denials through data analysis, adapting strategies accordingly for improved success rates in obtaining approvals.
- Collaborated with insurance companies to clarify coverage details and expedite review of complex cases.
Reef Family Pharmacy
PHARMACY TECHNICIAN
09.2014 - 03.2023
Job overview
- Receive written prescription or refill requests and verify that information is complete and accurate
- Establish or maintain patient proles, including lists of medications taken by individual patients
- Maintain proper storage and security conditions for drugs
- Receive and store incoming supplies, verify quantities against invoices, check for outdated medications in current inventory, and inform supervisors of stock needs and shortages
- Order, label, and count stock of medications, chemicals, or supplies and enter inventory data into computer
- Prepare and process medical insurance claim forms and records
- Assist in obtaining prior authorization for medications
- Maximized pharmacy efficiency through effective communication with staff members and adherence to procedures.
- Promoted patient confidentiality by adhering to HIPAA regulations when handling personal information during transactions.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
CVS Pharmacy
PHARMACY TECHNICIAN
01.2012 - 09.2014
Job overview
- Supply and monitor robotic machines that dispense medicine into containers and label the containers
- Receive written prescription or rell requests and verify that information is complete and accurate
- Maintain proper storage and security conditions for drugs
- Answer telephones, responding to questions or requests
- Establish or maintain patient proles, including lists of medications taken by individual patients
Education
WILDWOOD CATHOLICWildwood, NJ
High School Diploma
Atlantic Cape Community CollegeMays Landing, NJ
Associate of Applied Science from Health Sciences
05.2001
Skills
Diagnostic Imaging Billing Proficiency
Certification
Certified Pharmacy Technician
Timeline
Prior Authorization Specialist
COOPER UNIVERSITY HEALTH CARE REGIONAL
04.2024 - Current
Prior Authorization Specialist
Capsule Pharmacy
03.2023 - 04.2024
PHARMACY TECHNICIAN
Reef Family Pharmacy
09.2014 - 03.2023
PHARMACY TECHNICIAN
CVS Pharmacy
01.2012 - 09.2014
Atlantic Cape Community College
Associate of Applied Science from Health Sciences
05.2001
WILDWOOD CATHOLIC
High School Diploma
05.2009
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