Rachelle Marcum-Ward
Business Management/Prior Authorization Specialist
Amherst,Ohio
Summary
Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Overview
24
24
years of professional experience
2
2
years of post-secondary education
Work History
Precertification Supervisor
Quadax
01.2025 - 06.2025
- Promoted to Supervisor over the Prior Authorization Team
- Supervised 13 people
- Scheduling
- Time Sheets
- Distributed the work load amongst the Team
- Held 1:1 with each employee on a weekly basis
- Held a weekly Team meeting
- Audited the Team on a monthly basis ensuring quality and quantity
- Daily Reporting to make sure that the Prior Authorization cases stayed within the goals and did not go Out of Target.
Precertification Specialist
Quadax
09.2019 - 01.2025
- Receive requests for prior authorizations and ensure that they are properly and closely monitored
- Obtain pre-authorizations via phone, fax or insurance portals.
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
- Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
- Review accuracy and completeness of information requested and ensure that all supporting documents are present
- Track denials and submit appeals in a bid to get them approved from insurance companies
- Monitor patients’ records and accounts and ensure that pre-authorization information is properly updated in them
- Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPPA compliance and regulation
Workers Compensation Specialist
NOMS Access Orthopaedics
05.2017 - 09.2019
- Call MCO’s to give and receive information for BWC patients
- Completed all forms having to do with Ohio BWC - Provider
- Used ICD-10 coding; CPT Coding to ensure that patients paperwork would be approved
- Appeal process for patients when employers would appeal patients claims.
- Scheduled patients in a timely manner
Administrative Assistant
The Foundation Church
06.2016 - 05.2017
Administrative Specialist
Fisher-Titus Medical Center
04.2012 - 06.2016
- Scheduled appointments, gave information to callers, and otherwise relieved officials of clerical work and minor administrative business details.
- Read and routed incoming mail.
- Located and attached appropriate file to correspondence to be answered by employer.
- Compiled and typed statistical reports.
- Recorded minutes of staff meetings.
- Compiles committee data, as requested including charts, minutes, graphs, and correspondence letters.
- Records and submits productivity data on a quarterly basis.
- Matched order forms with invoices, and recorded the necessary information.
- Verified attendance, hours worked, and pay adjustments, and posted information onto designated records.
- Prepared monthly schedules, monitors and tracks employees PTO days, tardiness and overtime. Reports this to the Director on a monthly basis.
- Prepared purchase orders and expense reports.
- Understands accounting principles checking figures, postings and documents for correct entry, mathematical accuracy, and proper codes.
- Coded documents according to company procedures.
- Reconciled and noted and reported discrepancies found in records.'
- Performs administrative activities for the Director of Quality with the ability to work under pressure and maintain confidentiality.
- Maintains appointment calendar for Director; coordinates appointment and meetings.
- Works efficiently with Microsoft Office. Beginning to use the Crimson Software.
- Involved in Lean Healthcare, instructs Lean Healthcare, and monitors the projects that are submitted to the department.
Radiology Secretary
Fisher-Titus Medical Center
08.2008 - 04.2012
- Fostered a welcoming environment, addressing patient inquiries and concerns promptly and professionally.
- Demonstrated exceptional multitasking skills while handling high call volumes, prioritizing tasks effectively.
- Contributed to successful audits by adhering to HIPAA regulations and ensuring proper documentation management.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
Executive Secretary
Robins & Mortin
06.2005 - 08.2008
Office Manager
Sunrise Cooperative
07.2001 - 01.2005
Education
Associates Degree - Business Management
Ohio Business College
Sandusky, Ohio 01.1996 - 06.1998
High School - Business Academics
Norwalk High School
Norwalk, Ohio01.1988
Skills
- Effective communication
- Effectively manage stress in demanding environments
- Experienced with software applications
- Self-motivated strategist
- Swiftly adapt to protocols
- Efficient task management
- Creative thinker with innovative ideas
Awards
Graduated Magna cum Laude
Training
- How to Deal with Difficult People
- Many LinkedIn Courses
- Healthcare Lean Six Sigma
Timeline
Precertification Supervisor
Quadax
01.2025 - 06.2025
Precertification Specialist
Quadax
09.2019 - 01.2025
Workers Compensation Specialist
NOMS Access Orthopaedics
05.2017 - 09.2019
Administrative Assistant
The Foundation Church
06.2016 - 05.2017
Administrative Specialist
Fisher-Titus Medical Center
04.2012 - 06.2016
Radiology Secretary
Fisher-Titus Medical Center
08.2008 - 04.2012
Executive Secretary
Robins & Mortin
06.2005 - 08.2008
Office Manager
Sunrise Cooperative
07.2001 - 01.2005
Associates Degree - Business Management
Ohio Business College
01.1996 - 06.1998
High School - Business Academics
Norwalk High School
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