Paula Watts
Milwaukee,WI
Summary
Experienced Healthcare Operations Specialist with a successful background of over 30 years of experience. Detailed-oriented team player with strong analytical, organizational and problem resolution skills allowing for overall operational support, development and improvements. Strong rapport with internal and external customers based on knowledge, professionalism, strong work ethic and integrity. Enthusiastic and engaging professional eager to support employees advance in their knowledge and abilities through training and ongoing education with an emphasis in insurance discovery eligibility verification, referall processing, prior authorizations and utilization review. Adept at balancing business interests with a human centric service model. Motivated to learn, grow and excel in the healthcare operations industry.
Overview
30
30
years of professional experience
Work History
Revenue Cycle Management Analyst
Natera
05.2024 - Current
- Developed onboarding process and implemented successful onboarding program reducing new hire ramp-up time hired to fulfill various roles.
- Supported new hires, resulting in stronger staff development, increased productivity and improved learning outcomes with application of adult learning principles in all training programs.
- Wrote training manuals for the Revenue Cycle Management new hire employees according to evolving company guidelines and protocols.
- Provide expert guidance on best practices, resulting in improved overall organizational effectiveness.
- Collaborated with cross-functional teams to identify opportunities for process improvement and increased productivity.
- Evaluated existing systems and processes, identifying inefficiencies and recommending modifications for optimal performance.
- Evaluated current processes to develop improvement plans.
- Facilitated adoption of new technologies, conducting training sessions to ensure staff competence.
- Reviewed internal systems and organized training plans to address areas in need of improvement resulting in improved operational efficiency by implementing streamlines processes
Utilization Review Management Specialist
Froedtert Hospital
01.2021 - 05.2024
- Developed and facilitated the restructuring of Froedtert Community Hospital Division Case/Utilization Management Department to ensure most effective and efficient processes are implemented and in practice for a productive environment while decreasing denials by 33%
- Streamlined and monitor workflow by implementing efficient case management processes for optimal results, time management and increased productivity
- Developed, implemented and maintain training manual for Case/Utilization Management Specialist role to maintain long-term excellence
- Train and support continued education for staff development to ensure best practices within the department to support organization goals
- Insurance verification, request and obtain authorization for all in-patient and observation admissions, supporting utilization review through discharge
- Evaluate department operational practices and identify improvement opportunities with ongoing development revisions
- Collaborated with 10+ developers, project and operational management to build, implement and support the onboarding of a prior authorization platform using artificial intelligence to automate notice of admission and authorization process
- Ensured compliance with industry standards and regulations, conducting regular audits and implementing corrective actions when necessary.
- Display consistent, positive attitude towards customers, peers and other personnel even during high-stress situations
- Serve as subject matter resource, providing information related to a variety of health insurances guidelines, current medical policy language and authorization
- Apply strong leadership talents and problem-solving skills to maintain team morale and efficiency
Senior Insurance Authorization Specialist Lead III
Advanced Pain Management
01.2017 - 09.2020
- Conducted clinical review for verification to meet insurance guidelines including benefit verification, referral requirements and pre-authorization needs were met per insurance regulations and policy criteria
- Collaborated efficiently and effectively with staff, including members of operations, finance, billing and clinical departments
- Tracked all pending authorizations, internal and external referrals to resolve discrepancies and avoid revenue loss
- Demonstrated imperative flexibility and problem solving skills to support 16 specialty based providers with varying insurance industry laws, regulations and policy language guidelines
- Researched and resolved both routine and complex issues to support staff, providers and member's of operations
- Displayed consistent, positive attitude towards customers, peers and other personnel, even during high-stress situations
- Created and implemented successful training and development programs assuring continuous training to employees to promote long-term excellence
- Registration and scheduling of patients to ensure seamless patient care and streamlined revenue cycle management
- Analyzed medical records and other documents to determine medical necessity requests for specialty medical services and procedures
Ancillary Coordinator
Advanced Pain Management
10.2014 - 12.2016
- Coordinated Ancillary Department, supporting and training staff at multiple locations to ensure seamless operations to over 500 employees and patient care
- Improved team productivity with regular communication and progress updates, fostering collaborative work environment.
- Developed comprehensive reports for senior management, enabling informed decision-making based on data-driven insights
- Streamlined operations to efficiently process all medical equipment and supply orders including navigating medical policy language, obtaining authorization, shipment of orders, submission of claims in timely matter to ensure reimbursement and consolidate claims data
- Executed introduction and start up of internal pharmacy to meet high demands of specialty compounding services, meeting industry and federal guidelines
- Established and implemented company wide training, development and education to introduce and support all ancillary services and products
- Provided primary customer support to internal and external customers in fast-paced environment ensuring excellent customer service
- Coordinated with Managed Care department to resolve payer issues
- Conducted clinical review for verification to meet insurance guidelines including benefit verification and obtaining pre-authorization per insurance regulations and policy criteria
- Collected and analyzed data from various departments to prepare reports and presentations for management
- Evaluated operational practices and identified improvement opportunities to develop revisions for systems and procedures
- Audited and monitored all Ancillary Services for 29 specialty clinics and ambulatory surgery centers
Lead Authorization Specialist II
Advanced Pain Management
05.2005 - 10.2014
- Process eligibility, benefits verification and prior authorization requests
- Worked directly with insurance companies to review policy language and individual patient benefits for utilization review
- Determined clinical appropriateness of procedures based on policy language to protect patients and organization by minimizing risk and maximizing patient satisfaction
- Maintained strong knowledge of medical terminology to best understand services and procedures
- Established efficient workflow processes, monitored daily productivity and implemented modifications to improve overall effectiveness of personnel and business practices
- Supported authorization team of 15 team members with day-to-day operations and complex problems by applying motivational and analytical skills and strategies
- Trained new team members and provided continued education to diverse group
- Worked directly with registration, scheduling, admitting and claims departments to ensure seamless operations
- Enhanced departmental efficiency with thorough knowledge of insurance guidelines and medical terminology.
- Improved patient satisfaction by streamlining authorization processes and ensuring timely responses to inquiries.
Education
GED -
HSED
Racine, WISkills
- Analytical Skills
- Interpersonal Skills
- Medical Terminology Knowledge
- Critical Thinking
- Proficient in Microsoft Office and Google Enterprise Suites
- Healthcare Regulations Knowledge
- Solution Development and Optimization
- Interdisciplinary Collaboration
- Project Management
- Adaptability and Flexibility
- Adult Education
- Utilization Review
- Medical Terminology
- Workflow Development
- Insurance Verification, Coverage and Authorization
- Healthcare Revenue Cycle Management
Timeline
Revenue Cycle Management Analyst
Natera
05.2024 - Current
Utilization Review Management Specialist
Froedtert Hospital
01.2021 - 05.2024
Senior Insurance Authorization Specialist Lead III
Advanced Pain Management
01.2017 - 09.2020
Ancillary Coordinator
Advanced Pain Management
10.2014 - 12.2016
Lead Authorization Specialist II
Advanced Pain Management
05.2005 - 10.2014
GED -
HSED
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