Summary
Overview
Work History
Education
Skills
Timeline
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Nickie Lucas

Oro Valley,AZ

Summary

Reliable Manager demonstrating high level of ownership and initiative. Possessing exceptional work ethic and desire to go above and beyond to exceed company expectations. Offering a knack for building productive working relationships. Successful in fast-paced, deadline-driven environments to manage goals and team development. History of thriving in team-oriented environments.

Overview

30
30
years of professional experience

Work History

Client Services & Prior Authorization Manager

ObesityHelp
Irvine, CA
07.2015 - Current
  • Managed day to day operations of the PA team as well as provided expert resources to team members and additional assistance as needed
  • Reviewed PA's to ensure proper CPT and ICD10 codes utilize
  • Held weekly meetings with the team to ensure all PA were on target for submission/approval
  • Managed all incoming approval and denials from carriers, added them to the completed file and sent them over to the appropriate providers
  • Assisted team with insurance verification of benefits, request of prior authorizations for surgical procedures or other related procedures that required authorization, prior to surgery
  • On boarded all new clients which included setting them up in our system, setting up tracking of PA for each patient by client
  • Maintain weekly communication with provider offices to update them on the status of any prior authorizations that needed additional information or a peer to peer review
  • Maintained monthly reports outlining all Prior Authorization in stages of in process, approved, denied and appeal
  • Served as a liaison between company and providers
  • Relationship building and mentoring with physician offices and patients
  • Team building, hiring and employee annual reviews
  • Provided coaching and empowerment
  • Invoicing, accounts receivable and collections.

Surgical Coordinator/Prior Authorization Manager

McKenzie Regional Hospital
McKenzie, TN
03.2010 - 07.2015
  • Review Dr's orders and schedule necessary procedures accordingly
  • Verify eligibility and benefits to determine if the procedure is covered
  • Obtain necessary financial obligations of the patient and set up a financial plan that fits the hospital policy guidelines
  • Obtain prior authorization or precertification for scheduled procedures
  • Assemble and maintain medical records for upcoming scheduled procedures and deliver them to the Surgery Dept 48-72 hours in advance of the scheduled procedure
  • Determine availability of necessary equipment and supplies for scheduled procedures
  • Schedule radiology, equipment, and staff for special procedures
  • Schedule anesthesia with the network provider at the hospital.

Claims Supervisor

Great West Life
Kennett, MO
01.1997 - 09.2001
  • Claims Unit Supervisor managing 50 employees within a claims processing center in Kennett, MO
  • At this facility, we received all claims both on paper and electronically
  • Paper claims that met criteria guidelines were scanned and uploaded to the system for adjudication
  • Paper claims that did not meet the criteria were entered and adjudicated manually by my staff
  • As a Claim Supervisor, I was responsible for hiring, counseling, and coaching staff to ensure company objectives were met on a daily basis
  • This included maintaining a turnaround time for data entry of claims no more than 72 hours from the date of receipt and adjudication of claims within 10 days
  • Monitored workload and moved staff as needed for each staging process to be completed within the expected turnaround time
  • Served as a Team Leader, then promoted to Office Trainer prior to promotion to Claims Unit Supervisor.

Health Information Tech

Twin Rivers Regional Medical Center
Kennett, MO
08.1994 - 01.1997
  • Health Information Management Specialist
  • Assembled all inpatient and outpatient charts for processing and completion of provider signatures
  • Assisted in providing copies of medical records to various patients and third parties with proper signed authorization and designation
  • Daily and monthly reports related to census, births, deaths, and critical care air vac
  • Completion of birth registration with new mothers and uploaded those to the State Capital electronically.

Education

HS Diploma -

Katella High School
06.1987

Technical Mgmt -

UCLA Extension

Skills

  • Prior Authorization
  • Healthcare Revenue Cycle Management
  • Chart Review
  • EMR/EMH Record, CPT/ICD 10 knowledge, prior authorization and insurance guidelines
  • HIPAA Compliance
  • Strong medical terminology
  • Patient Financial Responsibility Collections
  • Hospital Physician Office Leadership/management
  • Strong customer service
  • Strong organizational, problem-solving, and communication skills
  • Strong analytical and critical thinking skills
  • Sales
  • Account Management
  • Client onboarding
  • Call center experience
  • Coaching and mentoring
  • CRM
  • Microsoft Office
  • Google Suite
  • Provide clinical data to case management or clinical review for prior authorizations
  • Track all inpatient and outpatient procedures monthly and compile reports
  • Maintain medical records, technical library, or correspondence files
  • Document all interactions with the patient and carrier into the system through the entire process
  • Register and pre-admit patients to the hospital as needed

Timeline

Client Services & Prior Authorization Manager

ObesityHelp
07.2015 - Current

Surgical Coordinator/Prior Authorization Manager

McKenzie Regional Hospital
03.2010 - 07.2015

Claims Supervisor

Great West Life
01.1997 - 09.2001

Health Information Tech

Twin Rivers Regional Medical Center
08.1994 - 01.1997

HS Diploma -

Katella High School

Technical Mgmt -

UCLA Extension

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Nickie Lucas