Mary Day
Middlesboro,KY
Summary
Proficient in medical coding and data entry, offering strong capabilities in verifying insurance eligibility and processing prior authorization requests. Focused on enhancing operational efficiency and compliance in healthcare settings.
Overview
25
25
years of professional experience
Work History
Medical Insurance Authorization Specialist
Elevation Occupational & Physical Therapy
Pineville, KY
08.2025 - Current
- Processed authorization requests for physical and occupational therapy procedures and services.
- Assisted patients in understanding their insurance benefits and requirements.
- Followed up on pending authorizations to ensure timely approvals.
- Maintained up-to-date knowledge of all changes in insurance plans, regulations, and procedures.
- Ensured accurate data entry of patient demographics, insurance details, and authorization numbers.
- Verified insurance eligibility for patients and entered information into the system.
- Scheduled peer-to-peer reviews for healthcare provider to discuss medical necessity with insurance providers.
- Maintained files for referral and insurance information, entering referrals into system.
- Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
- Utilized medical coding knowledge to accurately process and document authorization requests.
- Utilized insurance portals and phone calls to clarify coverage details and obtain prior authorization.
- Monitored changes in insurance policies and guidelines to ensure compliance with prior authorization processes.
- Organized information by using spreadsheets, databases or word processing applications.
- Collected payments, processed receipts and informed policyholders of outstanding balances.
- Communicated effectively with patients regarding office policies and procedures.
- Utilized electronic health record systems for accurate data entry and retrieval.
- Ensured compliance with HIPAA regulations regarding privacy of patient information.
- Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
Medical Insurance Authorization Specialist
Freedom Mobility Center
Middlesboro, KY
05.2025 - 08.2025
- Processed insurance authorizations for mobility equipment requests.
- Verified patient eligibility and benefits through insurance portals.
- Communicated with healthcare providers to gather necessary documentation.
- Maintained organized records of authorization requests and outcomes.
- Resolved discrepancies in authorization information efficiently.
- Coordinated with medical staff to provide appropriate documentation when needed for preauthorization requests.
- Responded promptly to inquiries from healthcare providers regarding status of authorizations.
- Acted as a liaison between providers and payers to facilitate timely authorization of services.
- Maintained up-to-date knowledge of all changes in insurance plans, regulations, and procedures.
- Managed daily workflow related to obtaining authorizations from various health plans including Medicare and Medicaid and commercial carriers.
- Reviewed medical records to ensure accuracy of diagnosis codes prior to submitting claims.
- Researched problem cases involving denials or incorrect payments due to lack of authorization or other issues.
- Advised physicians regarding coding issues that may affect payment or reimbursement decisions by third party payors.
- Assisted in resolving any discrepancies between submitted claims and insurance requirements.
- Ensured accurate data entry of patient demographics, insurance details, and authorization numbers.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Collaborated with internal departments to provide account status updates.
- Utilized medical coding knowledge to accurately process and document authorization requests.
- Maintained accurate and up-to-date records of authorization requests and outcomes in electronic health record systems.
- Monitored changes in insurance policies and guidelines to ensure compliance with prior authorization processes.
- Collaborated with fellow team members to manage large volume of claims.
- Organized information by using spreadsheets, databases or word processing applications.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
Section 8 Housing Coordinator
Cumberland River RHOAR
Middlesboro, Kentucky
02.2024 - 05.2025
- Managed HUD's Housing Choice Voucher Program for a women's long-term rehabilitation facility.
- Provided support to tenants in resolving any issues or concerns regarding their living environment.
- Assisted clients in understanding housing policies and procedures.
- Implemented property inspection procedures to maintain compliance with housing codes.
- Maintained residential tenancy agreements for renewal or termination following program guidelines.
- Assessed eligibility of applicants in accordance with predetermined criteria to fill vacancies.
- Processed rent payments from tenants according to lease terms and rental agreements.
- Coordinated tenant move-in and move-out activities including inspections, paperwork processing, and related tasks.
- Collaborated with local government agencies on initiatives related to affordable housing availability.
- Scheduled routine maintenance services for vacant units prior to occupancy.
- Assisted with the development and implementation of housing policies and procedures.
- Ensured all necessary documents were collected prior to approving a new tenancy agreement.
- Monitored compliance with housing regulations and codes to ensure safety standards were met.
- Built partnerships with related organizations to develop support and gain greater attention for important issues.
- Consulted and collaborated with other professionals to provide continuity of patient-family care.
- Reviewed physical structures for unusual deterioration or mismanagement to report to facilities and operations management.
- Offered support, referrals, and facilitated programs, like the Family Self-Sufficiency (FSS) program, to help families become self-sufficient.
- Interviewed potential clients, collecting personal information to determine eligibility for social assistance.
- Inspected vacated units upon move-out for damage assessment purposes.
Optical Office Manager
Mountain Optical
Middlesboro, KY
01.2019 - 02.2024
- Managed office supplies inventory to prevent shortages and maintain efficiency.
- Assisted in recruiting, onboarding and training new employees.
- Developed and implemented office procedures for improved workflow consistency.
- Communicated with vendors and service providers for timely support and services.
- Tracked invoices and payments to ensure accuracy of accounts receivable and payable information.
- Maintained impeccable office organization to support efficiency, professionalism and performance objectives.
- Supervised staff members, organized schedules and delegated tasks.
- Coded and entered daily invoices within the in-house EMR.
- Operated optical equipment for lens fitting and adjustments.
- Maintained inventory of frames and lenses, ensuring availability for customers.
- Processed insurance claims for eyewear purchases efficiently and accurately.
- Conducted repairs and adjustments on eyewear to ensure optimal fit and comfort.
- Collected customer measurements such as bridge, eye size, temple length, seg heights, vertex distance, pupillary distance and pantoscopic tilt.
- Telephoned appointment-holders on day before to confirm times, contacted no-shows, obtained insurance pre-authorization and notified patients upon eyewear availability.
- Instructed patients on insertion, removal, cleaning, care and proper handling of contact lenses.
- Assisted patients and customers with choice of frames to best fit budgetary requirements and style preferences.
- Ensured compliance with state regulations related to dispensing eyewear.
- Inspected finished lenses for accuracy of power and optical clarity.
- Analyzed chart in preparation of patient engagement to review diagnostic testing, photos and preventive measures needed.
- Processed insurance claims, verifying coverage and explaining benefits to patients.
- Coordinated referrals to ophthalmologists for patients requiring further medical treatment.
- Facilitated the ordering and dispensing of eyeglasses and contact lenses, ensuring timely delivery to patients.
- Managed patient follow-up care, scheduling routine examinations and monitoring ongoing treatments.
- Scheduled appointments, verified insurance coverage, and maintained accurate patient records.
- Inspected finished eyeglasses to conform to company's quality check process and verified proper fit to customer satisfaction.
Education
Certificate of Medical Billing And Coding - Medical Billing And Coding
SKCTC
Middlesboro, KY12-2015
Associate of Science - General Studies
SKCTC
Middlesboro, KY05-1998
Associate of Arts - Gender Studies
SKCTC
Middlesboro, KY05-1993
Skills
- Insurance verification
- Medical coding
- Prior authorization
- Electronic health records
- Data entry
- Healthcare compliance
Timeline
Medical Insurance Authorization Specialist
Elevation Occupational & Physical Therapy
08.2025 - Current
Medical Insurance Authorization Specialist
Freedom Mobility Center
05.2025 - 08.2025
Section 8 Housing Coordinator
Cumberland River RHOAR
02.2024 - 05.2025
Optical Office Manager
Mountain Optical
01.2019 - 02.2024
Certificate of Medical Billing And Coding - Medical Billing And Coding
SKCTC
Associate of Science - General Studies
SKCTC
Associate of Arts - Gender Studies
SKCTC