SARAH COOPER
Miami,FL
Summary
Clinical Business Operations Representative experienced in managing insurance authorizations and delivering financial services for patients. Enhanced patient satisfaction and ensured timely access to specialty care through effective communication with patients and providers. Focused on optimizing clinical operations to drive operational efficiency.
Clinical Business Operations Representative skilled in managing insurance authorizations and facilitating patient access to specialty care. Engages effectively with patients and providers to optimize operations and drive patient satisfaction through timely communications and proactive management.
Overview
15
15
years of professional experience
Work History
Clinical Business Operations Representative II
University of Miami
12.2022 - Current
- Engaged with patients and healthcare professionals to facilitate access to specialty care.
- Developed and implemented effective communication strategies with physicians, managers, colleagues, trainees, and staff.
- Reviewed clinical records for completeness, ensuring authorization, signatures, and required patient information were present.
- Scheduling for multiple providers with variability in appointment types. Actively addresses cancellations, reschedules, and any unexpected openings.
- Coordinated with internal and external facilities to verify receipt of patient orders and prescriptions, including referrals, diagnostic tests, medications, and durable medical equipment.
- Manage any assigned pools and ensure timely responses to messages from providers and requests from patients utilizing MyChart.
- Manages several phone lines for the department by triaging incoming calls, responding to inquiries, routing calls appropriately, and documenting messages in the appropriate software.
- Assists the department in managing expectations surrounding pre and post patient care.
Sr. Insurance Verification Representative
University of Miami
09.2021 - 12.2022
- Served as primary contact for patients and specialists, addressing inquiries and resolving issues related to referrals.
- Submits prior authorization requests to patients' insurance via phone, fax, or online portal and frequently checks status. Documents authorization progress to ensure approvals are on file prior to patient appointment or surgery.
- Tracked and documented referrals, ensuring accuracy of patient demographics and current insurance information.
- Prioritized and processed referrals based on urgency, ensuring timely resolution.
- Reviews details and expectations about the referral with both ordering providers and patients. Requests new referrals to be ordered when applicable.
Insurance Authorization Specialist
Planned Parenthood of the Pacific Southwest
01.2015 - 07.2020
- Obtain referrals, pre-certifications and pre-authorizations by 3rd party insurances and governmental payers.
- Managed high-volume inbound and outbound calls to facilitate timely insurance authorizations.
- Provide quality, efficient and non-judgmental telephone customer service to internal and external customers.
- Analyzed faxed requests and documentation to determine coverage and approval utilizing criteria and nurses for medical reviews.
- Conducted pre-visit financial counseling with patients to clarify insurance coverage and financial responsibilities.
Program Specialist
Randstad Staffing for Covance Pharmaceutical
11.2011 - 07.2014
- Responded to inbound customer calls, triaged and documented calls in database, and escalated issues per program specifications to ensure timely resolution.
- Screened and processed patient assistance applications, determined eligibility, and followed up with outbound calls to facilitate program access.
- Screened and processed patient assistance applications by determining eligibility and made outbound follow-up calls.
- Updated computer systems to reflect patient enrollment denials and approvals, ensuring accurate tracking of application statuses.
Education
Medical Billing and Coding Specialist Certification -
Kaplan College
San Diego, CASkills
- ICD-10 expertise
- CPT/HCPCS knowledge
- Knowledge of HMOs, Medicare and Medicaid
- Referral management
- Electronic Medical Record (EMR) software
- HIPAA compliance
- Working knowledge of insurance industry concepts
- Exceptional customer service
- Maintains strict confidentiality
- Self-motivated work ethic
Timeline
Clinical Business Operations Representative II
University of Miami
12.2022 - Current
Sr. Insurance Verification Representative
University of Miami
09.2021 - 12.2022
Insurance Authorization Specialist
Planned Parenthood of the Pacific Southwest
01.2015 - 07.2020
Program Specialist
Randstad Staffing for Covance Pharmaceutical
11.2011 - 07.2014
Medical Billing and Coding Specialist Certification -
Kaplan College