Samantha Mussard
Holden,MO
Summary
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 5 years of managing documentation. Considered team player with exemplary multitasking skills. Supervisory skills, identifying skill gaps and recommending training activities. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
8
8
years of professional experience
Work History
Prior Authorization & Billing Specialist
Transplant Genomics Inc.
10.2020 - Current
- Input all patient data regarding claims and prior authorizations into system accurately.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Communicated with patients regarding insurance status and out of pocket costs.
- Offered patients financial assistance.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Communicated with people from various cultures and backgrounds on application process.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
Prior Authorization & Billing Specialist
Lincare
06.2018 - 10.2020
- Input all patient data regarding claims and prior authorizations into system accurately.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Communicated with patients to compliantly use medical equipment.
M&M Millwrights
Self
01.2016 - 02.2018
- Estimated time and materials for projects to assist management in making informed decisions on project budgets.
- Documented repairs and maintenance activities to create reports for management.
- Kept detailed and accurate maintenance reports and documentation of progress.
- Handled all aspects of business: hiring, payroll, accounts receivable, collections, and inventory
Education
High School Diploma -
Oak Grove High School
Oak Grove, MO. 04.2009
Skills
- Issue Research
- Outpatient Procedures
- Strategic Initiatives
- Legal Requirements
- Medical Terminology
- Patient Interviews
- Benefit Coverage
- Medical Transcription
- Information Assistance
- Registration Paperwork
- Demographics Information
- Diagnostic Codes
- Patient Referral
- Insurance Information Oversight
- Problem Resolution
- Insurance Procedures
- Effective Communication Skills
- Health Insurance Plan Knowledge
- Patient Identification
- Explaining Patient Benefits
- Benefits Verifications
- Retro-Authorizations
- Authorizations
Timeline
Prior Authorization & Billing Specialist
Transplant Genomics Inc.
10.2020 - Current
Prior Authorization & Billing Specialist
Lincare
06.2018 - 10.2020
M&M Millwrights
Self
01.2016 - 02.2018
High School Diploma -
Oak Grove High School
Similar Profiles
Nicolet P. RuedigerNicolet P. Ruediger
Patient Collection Specialist at Eurofins- Transplant GenomicsPatient Collection Specialist at Eurofins- Transplant Genomics
Seble AdmassuSeble Admassu
Donor Coordinator at Bone Marrow Transplant and Stem Cell TransplantDonor Coordinator at Bone Marrow Transplant and Stem Cell Transplant
Grace EncarnacionGrace Encarnacion
Phlebotomist/Medical Assistant at Providence Clinical Genomics and GeneticsPhlebotomist/Medical Assistant at Providence Clinical Genomics and Genetics
Kelli HencheyKelli Henchey
Patient Access Representative at WMMC- Central Family & Sports MedicinePatient Access Representative at WMMC- Central Family & Sports Medicine
Daniel BaldwinDaniel Baldwin
Shop Supervisor at Herc RentalsShop Supervisor at Herc Rentals