Nicole Williamson
Atlanta,GA
Summary
Excelling in the Revenue Cycle as a reliable Prior Authorization Specialist/ AR Follow Up Representative, leveraging expertise in ICD-10 coding and critical thinking to streamline authorization processes, review claims, follow up on complex denials and patient accounts. Proactive approach and ability to establish key insurance company relationships led to improved efficiency and compliance, showcasing dedication to results and quality assurance. Very detailed, meticulous, and committed to all tasks never letting vital requests, projects, claims, or documents go unprocessed. Diligent tracker of patient and payer outcomes and providing feedback to assist with better streamlining processes. Incorporates empathetic communications with professional best practices to satisfy plan members, providers, payers, and patients by staying committed to the overall business goals.
Overview
14
14
years of professional experience
Work History
Revenue Cycle - Billing /AR Follow Up/Prior Authorization Specialist
Wellstar Heath System
Marietta, GA
11.2010 - Current
- Collaborated with 7physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to various insurance carriers to obtain prior authorization for testing and procedures.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Provided training to all new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched high volume of denied claims and contacted insurance companies to resolve these issues.
- Assisted in the development of departmental guidelines and procedures for prior authorization processes, improving overall efficiency.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
- Established strong relationships with key contacts at insurance companies, streamlining communication channels when resolving issues pertaining to approvals or denials.
- Identified trends in denials through data analysis, adapting strategies accordingly for improved success rates in obtaining approvals.
- Streamlined prior authorization processes by implementing efficient tracking systems.
- Processed patients lacking coverage for planned procedures.
- Conducted regular audits to ensure compliance with regulatory standards and insurance company policies related to the approval process.
Education
High School Diploma -
Stone Mountain High School
Stone Mountain, GA1992
Bachelor of Science - Currently Enrolled
Ashworth College
Norcross, GASkills
- Prior Authorization Process
- ICD-10 Coding Familiarity
- Medical Terminology
- Medical Appeals Handling
- Insurance Verification
- Medical terminology knowledge
- Claim research
- Claims processing experience
- Utilization Review Experience
- Critical thinking abilities
- Issue Research
- Quality Assurance Practices
- Documentation and paperwork
- Telephone Etiquette
- Eligibility Determination
- Proficiency in Epic
Timeline
Revenue Cycle - Billing /AR Follow Up/Prior Authorization Specialist
Wellstar Heath System
11.2010 - Current
High School Diploma -
Stone Mountain High School
Bachelor of Science - Currently Enrolled
Ashworth College