Mariah Gourley
Haysville,KS
Summary
Experienced with navigating healthcare insurance systems to secure treatment approvals. Utilizes keen attention to detail and extensive knowledge of medical coding to streamline processes. Strong understanding of insurance guidelines and patient advocacy to ensure optimal outcomes.
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing.
Experienced with managing appeals processes efficiently and effectively. Utilizes strong analytical skills and effective communication to resolve complex cases. Knowledge of regulatory standards and compliance ensures smooth operations and client satisfaction.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Pharmacy Technician
United Healthcare Group
09.2024 - Current
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
Pharmacy Technician
Walgreens Boots Alliance
10.2020 - 07.2024
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
- Promoted patient confidentiality by adhering to HIPAA regulations when handling personal information during transactions.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
Education
High School Diploma -
Northwest Highschool
Wichita05-2017
Skills
- Workflow optimization
- Insurance billing
- Medical terminology
- Medical coding
- Insurance policies
- Critical thinking
Certification
- Pharmacy Technician License - 10-31-2023-Current
Timeline
Pharmacy Technician
United Healthcare Group
09.2024 - Current
Pharmacy Technician
Walgreens Boots Alliance
10.2020 - 07.2024
High School Diploma -
Northwest Highschool
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