Robin Davis
Schenectady
Summary
Prior Authorization Coordinator and Medical Assistant with extensive knowledge of insurance policies, medical coding, and healthcare systems. Skilled in streamlining authorization processes, coordinating patient care, and ensuring compliance with regulatory standards. Proven track record of enhancing team productivity and improving patient satisfaction in fast-paced environments.
Overview
17
17
years of professional experience
Work History
Prior Authorization Coordinator
Community Care Physicians
Latham
02.2023 - Current
- Processed high volume of prior authorization requests within established turnaround times, ensuring adherence to quality standards.
- Coordinated with healthcare providers to efficiently gather patient information for timely prior authorization requests.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients.
- Collaborated with insurance companies to clarify coverage details and resolve issues related to prior authorization.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Assisted healthcare providers with appeals for denied authorizations by gathering necessary information and documentation to support reconsideration.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Maintained knowledge of ICD-10, CPT, HCPCS, and other relevant coding systems.
Medical Assistant
Malta Medical Care
Malta
10.2020 - 02.2023
- Conducted patient interviews to collect comprehensive health history and vital signs, ensuring accurate diagnosis and care.
- Provided assistance to medical staff in performing minor surgical procedures.
- Relayed patient messages to physicians regarding concerns, condition updates, and refill requests to support timely treatment decisions.
- Referred patients to specialized health resources and community agencies to enhance access to necessary support services.
- Interviewed physicians, pharmacists, and other healthcare providers regarding prior authorization requests for medications or services.
Prior Authorization Specialist
Albany Saratoga Center for Pain
Saratoga Springs
09.2019 - 10.2020
- Confirmed insurance eligibility and coverage prior to surgery to prevent delays and ensure patient readiness.
- Evaluated incoming referrals from primary care providers to ensure appropriate scheduling of procedures and appointments.
- Liaised with physicians, vendors, insurance companies, patients, and families to facilitate surgical procedures.
- Scheduled tests, lab work or x-rays for patients based on physician orders.
- Compiled and coded patient information or data in the appropriate computer system.
- Gathered current medical information and reviewed histories to gather details for the surgeons.
Medical Assistant/Prior Authorization Specialist
Saratoga Hospital
Charlton
02.2010 - 09.2019
- Collaborated with pharmacy staff to ensure accurate processing of medications requiring prior authorization.
- Facilitated prescription refills by communicating with pharmacies on behalf of supervising physician.
- Maintained knowledge of ICD-10, CPT, HCPCS, and other relevant coding systems.
- Performed EKGs, spirometry testing, and audiograms to support comprehensive patient assessments.
- Answered phones, scheduled appointments, greeted patients and ordered supplies.
Education
High School Diploma -
Ballston Spa High School
Ballston Spa, NY06-1990
Medical Coding -
Penn Foster Career School
Scranton, PA08-2026
Skills
- Authorizations
- Insurance verification
- ICD-10 coding
- CPT coding
- Medical coding
- Utilization review
- EHR proficiency
- Prescription management
- Medication management
- Pharmacy benefit management
- HIPAA compliance
Timeline
Prior Authorization Coordinator
Community Care Physicians
02.2023 - Current
Medical Assistant
Malta Medical Care
10.2020 - 02.2023
Prior Authorization Specialist
Albany Saratoga Center for Pain
09.2019 - 10.2020
Medical Assistant/Prior Authorization Specialist
Saratoga Hospital
02.2010 - 09.2019
High School Diploma -
Ballston Spa High School
Medical Coding -
Penn Foster Career School