RACHEL BLACKWELL
LYMAN,SC
Summary
Achieved timely approvals through effective management of prior authorization processes and meticulous record-keeping.,Drove healthcare compliance by applying knowledge of regulations and payer requirements for superior authorization management.,Enhanced process efficiency and aligned with industry standards to secure improved authorization outcomes.,Resolved preservice denials and managed backend claims appeals to facilitate smoother operations.
Overview
29
29
years of professional experience
1
1
Certification
Work History
CPC/Prior Authorization Coordinator
Bon Secours-Piedmont Orthopaedic Associates
Greenville, SC
08.1997 - Current
- Manages all surgery prior authorizations and insurance verifications for 17 surgeons including spine, sports medicine, total joints and upper/lower extremities
- (20 years' experience in medical office related work)
- Track and manage procedure schedules, ensuring current pre-certification status.
- Validated insurance eligibility and benefits through online resources or phone.
- Maintain accurate insurance policy data within Epic system.
- Verify receipt of all necessary pre-authorization documents prior to procedure
- Engage effectively with procedural facilities whenever needed.
- Assign appropriate ICD-10 and CPT codes pre-procedure based on documentation
- Advise surgeon of any additional clinical documentation needed in order to obtain pre-certification
- Set up Peer-to-Peers with insurance companies when required
- Pre-Service Appeals
- Implemented strategies for resolution by monitoring denial patterns in surgical cases.
- Perform other duties or functions as assigned
- Past Duties: Front Office Specialist
- Managed patient check-in and check-out processes.
- Obtained patients demographics and insurance information
- Collected co-insurance and co-payments
- Answered multi-line phone
- Scheduled office follow up appointments
- DME, MRI and PT pre-certainly
- Denials Team to assess trends
- Assist Supervisor with questions
Education
Certified Professional Coder -
AAPC
12.2013
Associates of Arts -
Greenville Technical College
01.1998
High School -
James F. Byrnes High School
01.1993
Skills
- Utilized medical terminology to facilitate clear communication with healthcare professionals
- Assisted in understanding anatomy for improved patient care
- Supported effective verbal communication among team members
- Applied detail-oriented skills to ensure accuracy in documentation
- Participated in pre-cert processes for patient procedures
- Collaborated with insurance companies to expedite claims processing
- Aided in addressing preservice denials and appeals for patient services
- Engaged in patient interaction to enhance their experience and satisfaction
- Facilitated conflict resolution to maintain a positive environment
- Maintained organization of patient records and documentation
- Demonstrated self-motivation in completing tasks independently
- Executed independent work on ICD-10 coding and CPT coding tasks
Certification
CPC through AAPC
References
Jennifer Ledwell
Michele Brooks
Liz Thompson
Cindy Morrel
Timeline
CPC/Prior Authorization Coordinator
Bon Secours-Piedmont Orthopaedic Associates
08.1997 - Current
High School -
James F. Byrnes High School
Certified Professional Coder -
AAPC
Associates of Arts -
Greenville Technical College