PAULA WATTS
Milwaukee,WI
Summary
Strategic healthcare operations professional with extensive experience managing patient access and authorization processes. Proven track record in reducing denial rates and optimizing workflows, leveraging deep knowledge of insurance policy guidelines to enhance compliance and operational efficiency.
Overview
21
21
years of professional experience
Work History
Revenue Cycle Management Analyst
Natera Inc.
05.2024 - Current
- Acted as Subject Matter Expert (SME) on insurance policy guidelines, enhancing case compliance and resolving complex authorization challenges.
- Identifies and shares trends with management to optimize business processes and boost overall operational effectiveness.
- Designed innovative training protocols and SOPs to streamline rapidly changing processes amid ambiguity.
- Followed through on quality assurance initiatives, ensuring 100% adherence to protocols.
Case Management Specialist Lead
Froedtert Hospital
Wauwatosa, WI
01.2021 - 05.2024
- Reduced denial rates by 33% by restructuring departmental processes and optimizing clinical workflows to secure payment channels.
- Drove innovation as a lead collaborator on an AI-driven platform to expedite notice of admission and authorization, reducing access delays.
- Coordinated interdisciplinary stakeholders (developers, payors, clinical teams) to enhance case accuracy and completeness.
- Managed urgent admissions and complex insurance verification requests with composure and professionalism to support timely patient access.
Senior Insurance Authorization Specialist Lead III
Advanced Pain Management
Greenfield, WI
01.2017 - 09.2020
- Interpreted complex medical records to validate medical necessity and ensure compliance with specialty service criteria for 16 provider groups.
- Safeguarded revenue by performing clinical assessments and navigating diverse insurance industry laws to mitigate patient out-of-pocket risk.
- Provided compassionate support during transitions of care, acting as the primary coordinator for patient registration and scheduling.
Ancillary Coordinator
Advanced Pain Management
Greenfield, WI
10.2014 - 12.2016
- Navigated medical policy language across 29 specialty clinics to secure prompt reimbursement and resolve payer issues.
- Partnered with managed care departments to solve complex customer problems and streamline payer-related barriers.
Lead Authorization Specialist II
Advanced Pain Management
Greenfield, WI
05.2005 - 10.2014
- Managed end-to-end eligibility, benefits verification, and prior authorization requests to support seamless patient access.
- Partnered directly with insurance carriers to review policy language and individual benefits for utilization review.
- Determined clinical appropriateness of procedures based on policy language to minimize organizational risk and maximize patient satisfaction.
- Established efficient workflow processes and monitored daily productivity, implementing modifications to improve overall business effectiveness.
- Supported an authorization team of 15 members with day-to-day operations and complex problem resolution using motivational and analytical strategies.
- Collaborated with registration, scheduling, admitting, and claims departments to ensure integrated and seamless healthcare operations.
Education
HSED -
Racine, WISkills
- Case Oversight
- Clinical Interpretation
- Strategic Navigation
- Patient Advocacy
- Compliance
- Innovation
- Software
- Expertise
- Data analysis
- Process optimization
- Revenue cycle management
- Risk mitigation
- Quality assurance
- Time management
- Training development
- Leadership skills
- Business process mapping
Timeline
Revenue Cycle Management Analyst
Natera Inc.
05.2024 - Current
Case Management Specialist Lead
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