Lisa Figueroa
Beaver,WV
Summary
Interested in seeking a position which will allow me to use my skills and grow within the company.
Overview
34
34
years of professional experience
Work History
Prior Authorization Specialist
West Virginia Pain Institute
Beckley, WV
06.2022 - Current
- Customer service. Appointment coordinator for in office procedures.
- Communicated with healthcare providers to obtain necessary documentation for approvals.
- Processed insurance authorization requests and verified coverage for procedures
- Reviewed prior authorization requests for accuracy and completeness, ensuring adherence to policies.
- Tracked turnaround times for prior authorizations and initiated follow-up actions to expedite approvals.
- Maintained organized records of all prior authorization requests and approvals.
- Utilized electronic health record systems to track patient authorization status efficiently.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Reviewed patient records for prior authorization requests.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Identified reasons behind denied claims and collaborated with insurance carriers to facilitate resolutions.
Prior Authorization Specialist
Carl Larson Cancer Center
Beckley, West Virginia
07.2017 - 06.2022
- Reviewed patient records for prior authorization requests at Carl Larson Cancer Center.
- Communicated with healthcare providers to secure required documentation for timely approval.
- Processed insurance authorizations and confirmed coverage for cancer treatment procedures, ensuring compliance with protocols.
- Coordinated treatment appointments to facilitate patient access to essential cancer therapies.
- Tracked turnaround times for prior authorizations and initiated follow-ups with relevant parties.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Coordinated with departments to gather additional information for prior authorization, facilitating smoother approval processes.
- Utilized electronic health record systems to track patient authorization status efficiently.
- Maintained organized records of all prior authorization requests and approvals.
- Maintained accurate records of all authorization activities in the database system.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
Practice Manager
Dr. Steve Childress DDS
Beckley, WV
08.2005 - 07.2017
- Managed practice operations effectively.
- Managed daily operations of dental practice ensuring smooth workflow.
- Oversaw all aspects of day-to-day practice operations including front desk reception, appointment scheduling, billing and coding, insurance verification.
- Billing and collection.
- Oversaw billing processes and maintained accurate financial records.
- Delivered exceptional customer service to ensure a positive patient experience.
- Assisted doctor with patient procedures.
- Facilitated communication between patients and dental team for optimal service delivery.
- Treatment consultation and planning.
- Assisting doctor with patient procedures as needed.
- Trained new employees on office protocols and patient interaction techniques.
- Proficient with Microsoft programs and various practice software.
- Complied with OSHA and HIPAA regulations.
Practice Manager
Diversey Dental Center
Chicago, Illinois
06.1992 - 08.2005
- Managed all financial aspects of the practice.
- Managed credit, collection, and billing processes to ensure timely payments.
- Developed and executed internal and external marketing strategies to enhance practice visibility.
- Handled human resource tasks for the organization.
- Excellent customer service.
- Provided excellent customer service through attentive assistance and prompt problem-solving.
- Assisted doctor with patient procedures.
- Trained new employees on company policies and procedures.
Education
Associates - Business
Northwestern Business College
Chicago, ILSkills
- Insurance verification
- Claims processing
- Documentation management
- Peer to peer scheduling
- Appointment scheduling
- Proficiency in Word, Excel
- Attention to detail
- Problem solving
- Excellent people skills
- Customer service
- Patient communication
Timeline
Prior Authorization Specialist
West Virginia Pain Institute
06.2022 - Current
Prior Authorization Specialist
Carl Larson Cancer Center
07.2017 - 06.2022
Practice Manager
Dr. Steve Childress DDS
08.2005 - 07.2017
Practice Manager
Diversey Dental Center
06.1992 - 08.2005
Associates - Business
Northwestern Business College