Natasia Thompson
Austin,TX
Summary
Experienced Authorization Specialist with a strong background at Centene Corporation, specializing in insurance claims processing and effective communication. Proven expertise in HIPAA compliance and prior authorization, ensuring timely adjudication and data accuracy. Achieved 100% completion of assigned applications, showcasing exceptional technical support and claims management skills. Committed to enhancing operational efficiency and accuracy within the healthcare sector.
Overview
8
8
years of professional experience
Work History
Authorization Specialist ll
Centene Corporation
Austin, Tx
03.2022 - Current
- Acts as a liaison between the hospital, health plans, physicians, patients, vendors, and other referral sources.
- Reviews complex referrals for completeness, and follows up for additional information if necessary.
- Verifies member insurance coverage and/or service/benefit eligibility via system tools, and aligns authorization with the guidelines to ensure a timely adjudication for payment.
- Performs data entry to maintain and update various authorization requests into the utilization management system.
- Supports and processes authorization requests for services in accordance with the insurance prior authorization list, and routes them to the appropriate clinical reviewer.
- Remains up to date on healthcare, authorization processes, policies, and procedures.
- Performs census reports for all states.
Senior Patient Services Coordinator
Austin Regional Clinic
Austin, Tx
03.2019 - 02.2022
- Assists other Business Office staff with front desk duties, answering phones, booking appointments, greeting patients, check-in/check-out, end of day processing & documentation
- Performs full patient registration functions which include collecting and entering all patient insurance and demographic information necessary to set up insurance coverage and patient accounts
- Generates and processes referrals and authorizations
- Responsible for opening front office and all duties associated with this function
- Verifies scheduling accuracy of MyChart appointments
- Researches and resolves problems with patient accounts in work queues process ABN's
Provider Enrollment
Dataquest
Austin, TX
03.2017 - 03.2019
- Responds to customer inquiries in a courteous and professional manner
- Research assistance requested and consistently provides accurate information to resolve internal and external member and provider inquiries via verbal and written communications through all channels including phone, email, web portal, and chat interactions
- Educates customers and dental professionals on eligibility, benefits, claims payment, and authorizations
- Interact professionally with providers and ancillary staff to provide appropriate and timely response to inquiries and concerns regarding provider enrollment and file maintenance for Medicaid programs
- Process to completion 100% of assigned applications utilizing documented work instructions daily and meet minimum daily quotas
- Data entry (of paper applications) with validation of provider submitted enrollment information to insure the enrollment application meets the minimum standards
- Assist members on gaining access to care by locating a network dentist or assignment to a primary care dentist
Education
Diploma -
Anderson High School
05.2004
Skills
- MS Word
- MS Excel
- Visual Basic
- HTML
- TruCare
- TruCare Cloud
- Salesforce
- Insurance claims processing
- Auto Claims
- Medical Transportation
- Billing/Coding
- Medical Insurance
- HIPAA Compliance
- Medical Terminology
- Technical Support
- HIPAA compliance
- Claims management
- Effective communication skills
- Data entry proficiency
- Prior authorization processing
References
Upon Request
Timeline
Authorization Specialist ll
Centene Corporation
03.2022 - Current
Senior Patient Services Coordinator
Austin Regional Clinic
03.2019 - 02.2022
Provider Enrollment
Dataquest
03.2017 - 03.2019
Diploma -
Anderson High School
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