Maggie VanCuran
Tonawanda,NY
Summary
Aiming to join a professional team where I can leverage my adept communication, clinical problem-solving, and organizational skills. With a comprehensive 12-year background encompassing all aspects of medical office operations, I'm excited to contribute to a quality-driven environment.
Overview
13
13
years of professional experience
Work History
Prior Authorization Specialist
GENERAL PHYSICIANS
07.2023 - Current
- Input all patient data regarding claims and prior authorizations into system accurately.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
Office Supervisor
Recruiting Sales, SUPPLEMENTAL HEALTHCARE
06.2022 - 07.2023
- Created and maintained reports, documents and presentations to assist with administrative support.
- Collaborated with other teams to identify areas of opportunity and implement changes to optimize sales operations and reporting.
- Built and maintained excellent customer relationships through timely response to inquiries and going above and beyond to accommodate unusual requests.
- Liaised between clients and vendors and maintained effective lines of communication.
- Assisted coworkers and staff members with special tasks on daily basis.
Medical Office Manager & Receptionist
TOUCH ADULT HEALTH
02.2017 - 06.2022
- Created and managed electronic patient records, encompassing data entry and administrative functions related to insurance, billing, and accounts receivable.
- Provided proper scheduling of patients, ensuring timely, and effective allocation of resources and calendars.
- Assessed processes and procedures, complying with OSHA, and HIPAA regulations.
- Addressed and remedied all patient or team member issues.
- Developed policies and procedures for effective practice management.
- Consulted with healthcare professionals on business decisions.
- Oversaw appointment scheduling.
- Identified opportunities to streamline processes and improve office operations and efficiency.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Obtained client medical history, medication information, symptoms, and allergies.
- Performed medical records management, including filing, organizing and scanning documents.
- Called and faxed pharmacies to submit prescriptions and refills. Including checking controlled scripts on NY PMP's website
- Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
- Verified patient insurance coverage and collected required co-payments.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Liaised with patients and addressed inquiries, appointment requests and billing questions.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Checked patient insurance, demographic, and health history to keep information current.
- Helped patients complete necessary medical forms and documentation.
- Managed multi-line phone system and pleasantly greeted patients.
- Organized paperwork such as charts and reports for office and patient needs.
- Used computer programs and registration systems to schedule patients for routine and complex procedures.
- Remained aware of provider schedules and scope of practice on evolving basis to organize and schedule appropriate care.
- Transcribed phone messages and relayed to appropriate personnel.
- Completed patient referrals to other medical specialists.
- Printed prescription requests and queries in compliance with practice protocol.
- Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
- Obtained payments from patients and scanned identification and insurance cards.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Greeted visitors and initiated triage processes for clients to streamline patient flow.
- Received and routed laboratory results to correct clinical staff members.
- Conducted patient intake interviews, recording and documenting relevant information.
- Managed office bookkeeping with insurance billing and patient payments.
Medical Receptionist / Billing Lead
PMAWNY
01.2011 - 02.2017
- Used data entry skills to accurately document and input statements.
- Responded to customer concerns and questions on daily basis.
- Audited and corrected billing and posting documents for accuracy.
- Handled account payments and provided information regarding outstanding balances.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Checked patient insurance, demographic, and health history to keep information current.
- Managed multi-line phone system for a large practice with over 15 health care providers.
- Organized paperwork such as charts and reports for office and patient needs.
- Verified and updated demographic and other personal information for clients with respect to personal boundaries when asking for important details.
- Verified patient insurance coverage and benefits for medical claims.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Followed up with medical staff regarding missing information in patient records.
- Scanned and uploaded medical records into electronic medical records system.
- Assisted in training new staff on medical record processing and filing procedures.
- Identified new methods to optimize medical records management.
- Reviewed medical records for completeness and filed records in alphabetic and numeric order.
- Transcribed and entered patient medical information into electronic medical records systems.
- Followed exact procedures for handling transfers and other releases of medical records.
- Identified and resolved discrepancies between patient information and claims data.
Education
NCCC
Billing & Medical Terminology
Continuing Education
Skills
- MEDENT
- Computer Proficient in Microsoft Word, Excel, Powerpoint, Outlook, various EMR systems, NYS HealthCommerce, HEALTHeLINK, RadMd, Infoclique, Evicore, UHC
- Medical Records Management
- HIPAA, BLS, CPR & OSHA trained
- Express Team Building – Leader
- Prior Auths
- Critical Thinking
- Time Management
- Scheduling
- Office Management
- Telephone Etiquette and Triaging
- Customer Service
- Completing Insurance Forms
- Patient Scheduling
- Specimen Collection
- Electronic Health Records
Timeline
Prior Authorization Specialist
GENERAL PHYSICIANS
07.2023 - Current
Office Supervisor
Recruiting Sales, SUPPLEMENTAL HEALTHCARE
06.2022 - 07.2023
Medical Office Manager & Receptionist
TOUCH ADULT HEALTH
02.2017 - 06.2022
Medical Receptionist / Billing Lead
PMAWNY
01.2011 - 02.2017
NCCC
Billing & Medical Terminology
Continuing Education
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