Michelle MacKenzie
Lowell,MA
Summary
Healthcare professional prepared for role with strong background in managing prior authorizations and fostering positive relationships with healthcare providers and insurance companies. Known for collaborative approach and consistently achieving results despite changing needs. Proficient in medical coding, insurance guidelines, and effective communication.
Overview
15
15
years of professional experience
Work History
Prior Authorization Specialist
Tufts Medicine - Melrose Wakefield Hospital
12.2019 - Current
- Coordinated prior authorization requests to ensure compliance with insurance protocols
- Streamlined communication between healthcare providers and insurance companies
- Reviewed medical records for accuracy and completeness of authorization submissions
- Educated staff on procedures for obtaining pre-approval for services
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Verified eligibility and compliance with authorization requirements for service providers.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
Insurance Verification Specialist
Wingate Healthcare
10.2015 - 07.2019
- Conducted thorough insurance verifications to ensure patient eligibility and coverage accuracy.
- Collaborated with healthcare providers to resolve discrepancies in patient insurance data.
- Streamlined verification processes, enhancing efficiency and reducing turnaround times for approvals.
- Developed training materials for new hires, focusing on industry regulations and best practices.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Demonstrated a high level of professionalism and attention to detail in all aspects of insurance verification specialist role, consistently exceeding performance expectations.
- Achieved insurance pre-authorizations to enable timely patient procedures.
Resource Coordinator
Genesis Healthcare
08.2010 - 09.2015
- Handle incoming referrals via phone or electronic interface for centers in 17 states
- Manage multiple accounts for both owned facilities and affiliate facilities
- Timely and accurate processing working files for Medicare, Medicaid and Commercial health plans
- Maintain strong relationships with Clinical Admissions Liaisons and Admission Directors
- Manage after hours and weekend on-call and emergency admissions
Education
Master Certification - Medical Billing, Coding And Administration
American International College
Woburn, MA04-2009
Bachelor of Arts - Communications
Suffolk University
Boston, Massachusetts, MA05-1995
Skills
- Prior authorization process
- Medical terminology
- Insurance verification
- Effective communication skills
- Medical coding
- Medical terminology knowledge
- Benefit coverage
- Insurance procedures
- Workflow management
- ICD-10 coding
Timeline
Prior Authorization Specialist
Tufts Medicine - Melrose Wakefield Hospital
12.2019 - Current
Insurance Verification Specialist
Wingate Healthcare
10.2015 - 07.2019
Resource Coordinator
Genesis Healthcare
08.2010 - 09.2015
Master Certification - Medical Billing, Coding And Administration
American International College
Bachelor of Arts - Communications
Suffolk University