Nicole Williamson
Loganville,GA
Summary
Knowledgeable and dedicated professional prepared to bring extensive expertise and results-oriented approach to Specialist role. Exceptional customer service skills with an above and beyond approach. Proven ability and track record of deliver favorable results. Known for effectively managing tasks and supporting organizational goals through collaborative efforts and adaptive strategies. Recognized for excellent communication and analytical skills, and ensuring seamless operations and consistent outcomes by utilizing effective problem solving skills.
Overview
15
15
years of professional experience
Work History
Prrecertification Specialist - Trainer
Wellstar Medical Group - Cardiovascular Medicine
11.2010 - Current
- Supported team in executing daily operational tasks and maintaining workflow efficiency.
- Assisted in data collection and analysis for process improvement initiatives.
- Collaborated with colleagues to address customer inquiries and resolve issues promptly.
- Maintained accurate documentation of processes and procedures for team reference.
- Collaborated with many 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.
- 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 fo 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 denials and communicated with payers to resolve issues.
- Streamlined processes and implemented a Quality Assurance metric for the team and did monthly QA's and follow up discussion with the team members.
- Contributed to team meetings by sharing insights on operational challenges and solutions.
- Engaged in training sessions to enhance understanding of company tools and systems.
- Adapted quickly to new software applications, enhancing productivity and task management abilities.
- Followed all company policies and procedures to deliver quality work.
Education
High School Diploma -
Stone Mountain High School
Stone Mountain, GASkills
- Exceptional Customer relations skills
- Expert problem solving
- Analytical thinking
- RTE / Authorization/Billing/Insurance Knowledge
- Process ICD-10 Coding and Medical Terminology
- Handling Insurance Verification
- Critical thinking abilities
- Issue Research
- Quality Assurance Practices
- Telephone Etiquette
- Proficiency in Epic
Timeline
Prrecertification Specialist - Trainer
Wellstar Medical Group - Cardiovascular Medicine
11.2010 - Current
High School Diploma -
Stone Mountain High School
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