Rachel Deck
Foster,WV
Summary
Dynamic Prior Authorization Specialist with proven success at Boone Memorial Hospital, adept at navigating complex insurance verification and authorization processes. Skilled in effective communication and critical thinking, achieving a high success rate in securing authorizations through meticulous documentation and proactive follow-up. Committed to enhancing patient care and streamlining workflows.
Overview
3
3
years of professional experience
Work History
Prior Authorization Specialist
Boone Memorial Hospital
Madison, WV
09.2022 - Current
- Processed prior authorization requests accurately and efficiently to ensure timely patient care.
- Reviewed insurance documentation and verified benefits for medical services.
- Communicated with healthcare providers to obtain necessary clinical information for authorizations.
- Maintained comprehensive records of authorization requests and outcomes in electronic systems.
- Collaborated with team members to streamline workflows and improve processing times.
- Collaborated with 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 insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- 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.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
Education
No Degree - Pre Reqs
SWVCTC
LoganHigh School Diploma - General Studies
Van Jr Sr High School
Van, WV06.1994
Skills
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Insurance verification
- Authorizations
- Effective communication skills
- Patient referrals
- Data entry
- Electronic health records proficiency
- Physician order verification
- Medical terminology knowledge
- Benefit coverage
- Medical office procedures
- Professionalism and ethics
- Insurance procedures
- Retro-authorizations
- Patient confidentiality compliance
- Records maintenance
- Pharmacy benefit management
- Patient scheduling
- Provider relations
- Claims processing experience
- Claim research
- Utilization review experience
- Critical thinking
- HIPAA compliance
- Healthcare regulations
- Precertification requirements
- Practitioner order verification
- Multitasking
- Problem-solving
- Telephone etiquette
- Documentation and paperwork
Timeline
Prior Authorization Specialist
Boone Memorial Hospital
09.2022 - Current
No Degree - Pre Reqs
SWVCTC
High School Diploma - General Studies
Van Jr Sr High School