Job Search Status
Open to workDesired start date: Open to discussion
Open To Work
Lora Alexander
Millington,TN
Work Preference
Summary
Detail-oriented professional with a robust background in prior authorization and medical appeals handling. Known for professionalism and ethics, successfully facilitating communication between patients and providers to streamline authorization processes and enhance service efficiency.
Overview
19
19
years of professional experience
Work History
Prior Authorization Specialist
St Francis Cardiology
Bartlett, TN
01.2007 - Current
- Reviewed and analyzed prior authorization requests for medical procedures and services.
- Collaborated with healthcare providers to gather necessary documentation for approval processes.
- Ensured compliance with insurance guidelines and company policies during authorization reviews.
- Facilitated communication between patients, providers, and insurance companies to resolve authorization issues.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Implemented process improvements to enhance turnaround times for authorization approvals.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Verified eligibility and compliance with authorization requirements for service providers.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Tracked referral submission during facilitation of prior authorization issuance.
- Identified trends in denials through data analysis, adapting strategies accordingly for improved success rates in obtaining approvals.
- Increased approval rates for necessary medical procedures by providing detailed justifications and patient history during review process.
Education
High School Diploma -
Millington Central High School
MillingtonSkills
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Insurance verification
- Patient referrals
- Data entry
- Electronic health records proficiency
- Professionalism and ethics
- Retro-authorizations
- Patient scheduling
- Medical coding
- HIPAA compliance
Timeline
Prior Authorization Specialist
St Francis Cardiology
01.2007 - Current
High School Diploma -
Millington Central High School