Margo Love
Grandview,MO
Summary
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 10 years of managing documentation. Considered team player with exemplary multitasking skills.
Experienced in managing prior authorization processes, including verifying eligibility and compliance with payer guidelines for healthcare services. Demonstrated ability to prepare denial letters and facilitate peer-to-peer reviews, effectively communicating with physicians and insurance carriers to resolve authorization issues. Skilled in patient data management within EMR systems, handling up to 500 patients while ensuring accurate documentation and timely responses to inquiries from medical staff. Collaborated with healthcare teams to maintain a patient-centered environment, supporting diagnostic procedures and managing medical records efficiently.
Overview
22
22
years of professional experience
Work History
Prior Authorization Specialist
Mid America Gastro- Intestinal Consultants
09.2010 - 03.2023
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures with Doctor's, setting up Peer to Peer reviews when needed.
- Verified eligibility and compliance with authorization requirements for service providers.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Input all patient data regarding claims and prior authorizations into EMR
- Managed up to 500 patients.
- Processed patients lacking coverage for planned procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues
- Verified eligibility and compliance with authorization requirements for service providers
Medical Assistant
College Park Family Care
05.2001 - 09.2009
- Collected pertinent data and calculations to aid physician in interpreting results.
- Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment.
- Supported duties for diagnostic and technical treatment procedures, such as setting up and operating special medical equipment and apparatus.
- Prepared lab specimens for diagnostic evaluation.
- Performed medical records management, including filing, organizing and scanning documents.
- Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
- Managed up to 60 patients per day.
Education
Certified - Medical Assistant
Johnson County Community College
Overland Park, KSSkills
- Patient Referral
- Issue Research
- Demographics Information
- Benefits Verifications
- Health Insurance Plan Knowledge
- Effective Communication Skills
- Specialist Procedures
- Patient Scheduling
- Referral Tracking
- Knowledge of ICD 10 codes pertaining to biologic infusions
- Prior Authorization
- Eligibility verification
- Patient data management
Timeline
Prior Authorization Specialist
Mid America Gastro- Intestinal Consultants
09.2010 - 03.2023
Medical Assistant
College Park Family Care
05.2001 - 09.2009
Certified - Medical Assistant
Johnson County Community College