Patricia Carroll
Farmington,NM
Summary
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over [Number] years of managing documentation. Considered team player with exemplary multitasking skills. Leadership abilities, self starter, excellent communication skills, reliable.
Overview
20
20
years of professional experience
Work History
Prior Authorization Specialist
San Juan Regional Health Partners- Interventional
08.2018 - Current
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Tracked referral submission during facilitation of prior authorization issuance.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Helped develop a Radiology workflow from when the order is written until patients test is completed.
- Developed a template for my providers to simplify prior authorization needs and improve patient care.
- Assisted various other clinics with their Prior Authorizations submissions including Cardiology, Internal Medicine, Pediatrics, Neurosurgery and Physiatry.
Customer Service Representative
San Juan Health Partners - Heart Center
04.2015 - 08.2018
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Check in, check out and verify insurance eligibility.
- Schedule patient appointments and build appointment templates.
- Manage medical records gathering and requests.
- Handle incoming phone calls for a very busy clinic.
General Manager
Blue Moon Diner
06.2012 - 03.2015
- Increased overall company efficiency by streamlining operations and implementing innovative managerial strategies.
- Monitored financial performance, set budgets and controlled expenses to provide financial stability and long-term organizational growth.
- Analyzed market trends/data to identify potential opportunities for business growth within existing or emerging markets successfully.
- Observed each employee's individual strengths and initiated mentoring program to improve areas of weakness.
Event Manager
SunRay Park And Casino
09.2004 - 05.2012
- Implemented protocols and procedures to effectively manage planning process.
- Analyzed event costs to identify areas of improvement and cost savings.
- Conducted post-event evaluations to identify areas for improvement and implement necessary changes in future planning efforts.
- Reduced event costs by negotiating favorable terms with suppliers and vendors without compromising on quality or service levels.
- Trained and supervised event staff to complete tasks on time.
- Supported senior leadership by developing status reports on activities related to planning, scheduling, cancellation, inquiries, resourcing, risk mitigation, and proposal development for various events.
Education
High School Diploma -
Taft Union High School
TaftSkills
- Patient Confidentiality Compliance
- Medical Terminology
- Understanding of medical terms
- Authorizations
- Medicare and Medicaid knowledge
- Provider Relations
- Medical Appeals Handling
- Critical thinking abilities
- Use 15 Web Portals to obtain prior authorizations including Cohere and HealthHelp
Timeline
Prior Authorization Specialist
San Juan Regional Health Partners- Interventional
08.2018 - Current
Customer Service Representative
San Juan Health Partners - Heart Center
04.2015 - 08.2018
General Manager
Blue Moon Diner
06.2012 - 03.2015
Event Manager
SunRay Park And Casino
09.2004 - 05.2012
High School Diploma -
Taft Union High School
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