Lynne Zander
Neenah,WI
Summary
Dynamic Prior Authorization Specialist with a proven track record at Navitus, excelling in the prior authorization process and effective communication. Achieved a high success rate in obtaining authorizations through comprehensive documentation and critical thinking. Skilled in electronic health records and committed to enhancing patient satisfaction and workflow efficiency.
Overview
31
31
years of professional experience
Work History
Prior Authorization Specialist
Navitus
04.2014 - Current
- Reviewed insurance policies to determine prior authorization requirements for medical procedures.
- Communicated with healthcare providers to gather necessary documentation for authorization requests.
- Inputted and tracked authorization requests using electronic health record systems.
- Assisted in resolving issues related to denied prior authorizations with appropriate follow-up actions.
- Educated patients on the prior authorization process and addressed inquiries regarding their cases.
- Collaborated with team members to ensure timely processing of authorization requests.
- Maintained accurate records of all authorization communications and decisions for audit purposes.
- Verified eligibility and compliance with authorization requirements for service providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- 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.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
- Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.
- Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Continually updated knowledge on industry developments, ensuring adherence to best practices and relevant regulatory changes impacting the prior authorization process.
- Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.
- Developed and maintained productive working relationships with healthcare providers.
- Participated in cross-functional initiatives to improve overall efficiency and effectiveness of the prior authorization process for all involved parties.
- Identified trends in denials through data analysis, adapting strategies accordingly for improved success rates in obtaining approvals.
- Streamlined prior authorization processes by implementing efficient tracking systems.
- Implemented tracking system for prior authorization requests to monitor progress and identify bottlenecks.
- Participated in quality improvement initiatives aimed at reducing errors and enhancing patient satisfaction with authorization process.
- Developed comprehensive database of insurance requirements and medication coverage to streamline prior authorization process.
- Increased approval rates for necessary medical procedures by providing detailed justifications and patient history during review process.
- Conducted thorough reviews of medical documentation to ensure compliance with payer policies and patient care standards.
- Streamlined submission of prior authorization requests, leading to faster patient access to needed treatments.
- Collaborated with insurance companies to clarify coverage details and expedite review of complex cases.
- Maintained up-to-date knowledge of changing healthcare regulations and insurance policies to ensure accurate processing of requests.
Sales Representative
Converges
01.1995 - 02.2014
- Developed and maintained strong customer relationships to drive repeat business.
- Executed strategic sales initiatives, increasing product visibility in targeted markets.
- Analyzed customer feedback to enhance service delivery and product offerings.
- Monitored market trends to identify new opportunities for revenue growth.
- Conducted regular performance reviews to assess team effectiveness and set goals.
- Implemented CRM systems for improved tracking of customer interactions and sales data.
- Enhanced client satisfaction by addressing concerns promptly and providing exceptional service.
- Generated additional sales opportunities with upselling and cross-selling techniques.
- Expanded customer base through cold calling, networking, and relationship building.
- Increased sales revenue by identifying and targeting high-potential accounts.
- Maintained up-to-date knowledge of industry trends for informed decision-making during client interactions.
- Consistently met or exceeded quotas by implementing strategic sales plans and effective time management.
- Conducted product demonstrations to educate customers on features, benefits, and competitive advantages.
- Increased repeat business by fostering trust-based relationships with key accounts through regular communication.
- Developed tailored solutions in response to unique customer needs, increasing overall satisfaction rates.
- Achieved top performer status consistently through dedication to meeting goals and exceeding expectations.
- Collaborated with marketing to create impactful promotional materials for increased brand awareness.
Education
Marketing
Fox Valley Technical College
Appleton, WI06.1991
Skills
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Authorizations
- Effective communication skills
- Patient referrals
- Data entry
- Electronic health records proficiency
- Medical terminology knowledge
- Benefit coverage
- Professionalism and ethics
- Process improvement strategies
- Workflow management
- Insurance procedures
- Retro-authorizations
- Patient confidentiality compliance
- Pharmacy benefit management
- Claims processing experience
- Quality assurance practices
- Knowledgeable in software
- Critical thinking
- HIPAA compliance
- Healthcare regulations
- Insurance information oversight
Timeline
Prior Authorization Specialist
Navitus
04.2014 - Current
Sales Representative
Converges
01.1995 - 02.2014
Marketing
Fox Valley Technical College