LELA BARRETT
BRADENTON
Summary
Experienced administrative professional with 10+ years in provider credentialing services,medical billing and prior authorizations. Works productively with facilities, provider groups and individual professionals. Knowledgeable about application requirements for government and private insurance plans.
Overview
17
17
years of professional experience
Work History
Billing & Credentialing Specialist
Ramos Center for Interventional & Functional Pain Medicine
11.2020 - Current
- Maintain providers CAQH and PECOS logins updated & attested
- Complete insurance enrollment applications in accordance with practice standards
- Responsible for initial credentialing with insurance companies and reviewing contracts
- Maintain provider contract files and knowledge of current health plans and requirements
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions and on boarding new providers.
- Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
- Developed strong relationships with external organizations, leading to increased cooperation during verification processes.
- Review EOB'S and denials, review medical records, prepare appeals
- ICD-10 & CPT coding for outpatient procedures and office visits.
- Increased overall efficiency by streamlining processes for reviewing and submitting insurance claims while maintaining high accuracy rates.
- Enhanced team productivity by providing ongoing training in ICD-10-CM, CPT, and HCPCS code sets as needed.
Authorization Specialist Lead
Ramos Center for Interventional & Functional Pain
08.2016 - Current
- Review patient insurance coverage to submit prior authorizations
- Prevented delays in care delivery by proactively identifying potential issues during the pre-authorization process and seeking clarification from providers when needed.
- Coordinate peer to peer discussions
- Monitor and track authorizations
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Handled between 300-500 Procedure and office visit authorizations a week
- Imaging authorizations
- Reviewing clinical documentations to insurance medical necessity guidelines to prevent denials
- Insurance authorizations appeals.
Authorization Specialist
Sarasota Pain Relief Center
01.2013 - 08.2016
- Review patient insurance coverage to submit prior authorizations
- Prevented delays in care delivery by proactively identifying potential issues during the pre-authorization process and seeking clarification from providers when needed.
- Coordinate peer to peer discussions
- Monitor and track authorizations
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Handled between 300-500 Procedure and office visit authorizations a week
- Imaging authorizations
- Reviewing clinical documentations to insurance medical necessity guidelines to prevent denials
- Insurance authorizations appeals.
Registered Pharmacy Technician
Walgreens Pharmacy
08.2008 - 01.2013
- Utilized advanced computer systems for prescription processing tasks such as inputting orders, updating patient profiles, and generating labels accurately.
- Demonstrated strong attention to detail when preparing customized compound medications per pharmacist instructions meeting the unique needs of individual patients.
- Mentored new pharmacy technicians during their training period, fostering a supportive team atmosphere focused on delivering quality patient care.
- Maintained a clean and safe work environment, adhering to established guidelines for infection control and hazardous waste management.
- Effectively managed high-pressure situations by prioritizing tasks focusing on time-sensitive needs.
- Communicated with insurance companies resolving billing issues promoting seamless coverage for customers.
- Ensured accurate dosage calculations and proper labeling of medications, improving overall patient safety.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
Education
Certified Credentialing Specialist Course
AAPC
Remote01-2025
Medical Billing and coding certification -
AAPC
01.2022
High School -
Bayshore High School
01.2008
Skills
- HIPAA compliance
- Credentialing oversight
- Insurance procedures
- Provider enrollment
- Data management
- EMR- ECW
- Data entry
- Time management
- Friendly, positive attitude
- Attention to detail
- Team collaboration
- Customer service
- Problem-solving
- Flexible and adaptable
Timeline
Billing & Credentialing Specialist
Ramos Center for Interventional & Functional Pain Medicine
11.2020 - Current
Authorization Specialist Lead
Ramos Center for Interventional & Functional Pain
08.2016 - Current
Authorization Specialist
Sarasota Pain Relief Center
01.2013 - 08.2016
Registered Pharmacy Technician
Walgreens Pharmacy
08.2008 - 01.2013
Medical Billing and coding certification -
AAPC
Certified Credentialing Specialist Course
AAPC
High School -
Bayshore High School
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