Margie Grubish
Owatonna,MN
Summary
Experienced administrative professional specializing in prior authorization and medical compliance. Proven ability to enhance patient outcomes through effective communication and problem-solving skills. Committed to improving operational procedures and ensuring adherence to medical standards in a fast-paced environment.
Overview
21
21
years of professional experience
Work History
Prior-Authorization Coordinator
M Health Fairview
Minneapolis, Minnesota
06.2024 - Current
- Secured authorization notifications and pre-certifications for patients through effective communication with insurance carriers.
- Performed detailed medical reviews of prior authorization requests according to established criteria and protocols.
- Ensured compliance with authorization processes by monitoring changes in insurance policies and guidelines.
- Analyzed trends in authorization denials and reported findings for quality improvement initiatives.
- Communicated with patients compassionately while safeguarding medical information confidentiality.
- Maintained professionalism while interacting with external customers, including physicians' offices and insurance companies.
- Gathered case histories and completed intake forms by conducting patient interviews to ensure comprehensive understanding of medical needs.
- Prepared reports, invoices, letters, and medical records using various software applications.
Referral/Prior-Authorization Coordinator
Mayo Clinic Health System
Owatonna, MN
02.2005 - 03.2022
- Verified patient insurance coverage, including eligibility benefits and authorizations for medical services.
- Reviewed prior authorization requests to ensure accuracy and completeness.
- Coordinated interdepartmental communication to gather necessary information for timely prior authorization.
- Contacted insurance carriers for authorization notifications and pre-certifications.
- Scheduled peer-to-peer reviews for physicians regarding medical necessity with insurers.
- Trained new staff on prior authorization procedures, enhancing team knowledge and efficiency.
- Established and maintained relationships with external vendors to streamline pre-authorization services.
- Ensured compliance with insurance policies and regulatory guidelines.
Health Unit Coordinator
Owatonna Hospital
Owatonna, MN
03.2007 - 06.2009
- Communicated critical patient information to healthcare team promptly.
- Coordinated interdepartmental communication to ensure seamless patient care.
- Responded swiftly to patient call lights, ensuring timely follow-through.
- Assisted nursing staff with patient care activities, enhancing patient support.
- Conducted unit greetings and orientations for newly admitted and transferred patients.
- Provided customer service to address patient inquiries about care plans.
- Verified insurance coverage prior to patient visits for service efficiency.
- Conducted quality assurance checks on patient records, ensuring accuracy and compliance.
Education
Associate of Science - Medical Assistant
Med-Assist School of Hawaii
Honolulu, HI05-1999
Bachelor of Arts - Hotel and Restaurant Management
La Consolacion College
Manila, Philippines05-1996
Skills
- Prior authorization expertise
- Insurance knowledge
- Medical software navigation
- Detail orientation
- Advanced problem solving
- Organizational skills
- Medical coding expertise
- Utilization review
- Microsoft Office proficiency
- Effective communication skills
- Task efficiency
- Customer management
Accomplishments
- Mae Berry Award Nominee (Mayo Clinic)
Timeline
Prior-Authorization Coordinator
M Health Fairview
06.2024 - Current
Health Unit Coordinator
Owatonna Hospital
03.2007 - 06.2009
Referral/Prior-Authorization Coordinator
Mayo Clinic Health System
02.2005 - 03.2022
Associate of Science - Medical Assistant
Med-Assist School of Hawaii
Bachelor of Arts - Hotel and Restaurant Management
La Consolacion College