SHELIA GILBERT
Parkersburg,WV
Summary
Dynamic Authorization Specialist with extensive experience at Parkersburg Cardiology, excelling in 10 years prior authorization processing and effective communication. Proven track record of optimizing workflows and achieving high productivity, while ensuring HIPAA compliance. Adept at insurance verification and documentation, consistently enhancing patient care through timely updates and collaboration with healthcare teams.
Over 20 years experience working in a fast paced hospital and office setting
Overview
22
22
years of professional experience
Work History
Authorization Specialist
Parkersburg Cardiology
08.2015 - Current
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Contributed to team goals by consistently meeting or exceeding individual productivity targets for processing authorization requests.
- Assisted in training new team members on company policies and procedures for handling authorization requests.
- Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during the authorization process.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Demonstrated adaptability with changing insurance requirements, maintaining up-to-date knowledge through continuous education efforts.
- Expedited claim processing by submitting complete and accurate information in accordance with payer requirements.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Ensured prompt resolution of denied claims through comprehensive analysis of denial reasons and timely submission of necessary documentation for reconsideration or appeal.
Insurance Verification Clerk
Parkersburg Cardiology
08.2015 - Current
- Collaborated closely with medical staff, fostering a cohesive environment that led to smoother operations and enhanced patient experience.
- Streamlined communication with insurance providers, expediting the verification process for faster approvals.
- Contributed to improved cash flow by minimizing billing errors through thorough insurance verification procedures.
- Enhanced claim processing efficiency by meticulously verifying insurance coverage and eligibility.
- Reduced claim denials by diligently reviewing patient information and ensuring accuracy in data entry.
- Served as a reliable resource for colleagues regarding complex cases, offering guidance based on extensive knowledge of various insurance plans.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Updated patient records with accurate, current insurance policy information.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Achieved insurance pre-authorizations to enable timely patient procedures.
Medical Records Clerk
Parkersburg Cardiology
08.2015 - 12.2018
- Ensured HIPAA compliance by adhering to strict confidentiality guidelines when handling sensitive patient information.
- Maintained confidentiality of all medical records and sensitive information to comply with HIPAA regulations.
- Processed medical records requests from outside providers according to facility, state, and federal law.
- Scanned medical records in digital format for easy retrieval and accessibility.
- Printed and photocopied documents to provide patients with copies of medical records.
- Assisted in preparation of medical records to release to other medical facilities requesting for patient history and information.
- Uploaded physician progress notes, history, and physicals into electronic medical records.
- Maintained patient records in compliance with security regulations.
- Responded effectively to requests for medical records from legal representatives, insurance companies, and other authorized parties in a timely manner.
Cardiology Tech
Camden Clark Medical Center
01.2013 - 08.2015
- Monitored patient comfort and safety during tests, alerting physicians to abnormalities or changes in patient responses.
- Maintained clean and orderly procedure rooms, storage areas, dressing rooms and film storage areas.
- Maintained adequate supplies and reported equipment deficiencies and failures.
- Conducted quality control checks on Cath Lab equipment, ensuring optimal performance and patient safety.
- Provided compassionate care to patients throughout testing, alleviating anxiety and addressing concerns as needed.
- Streamlined test preparation processes, leading to increased efficiency and reduced wait times for patients.
- Ensured patient safety during procedures by diligently monitoring vital signs and promptly addressing any abnormalities.
- Enhanced diagnostic accuracy through meticulous attention to detail in EKG interpretation and data recording.
- Managed confidential medical records efficiently, adhering to strict HIPAA guidelines at all times.
- Collaborated effectively with multidisciplinary teams, fostering clear communication and optimal patient outcomes.
- Conducted regular equipment maintenance checks to ensure proper functionality during critical diagnostic procedures.
- Educated patients on pre-test preparations, enabling them to arrive prepared for their appointments, thus reducing delays or cancellations.
- Assisted physicians in identifying potential cardiac issues by providing thorough documentation and timely test results.
- Improved patient care by accurately administering and monitoring cardiac stress tests.
- Provided vital assistance during emergency situations, acting quickly to administer life-saving interventions under physician guidance.
Unit Clerk
Camden Clark Medical Center
07.2011 - 08.2015
- Answered unit calls and took messages for healthcare staff to maximize team productivity.
- Answered multi-line telephone system, provided information, and directed calls.
- Handled incoming calls professionally, providing relevant information or transferring inquiries as needed to maintain efficient communication channels within the unit.
- Prepared admissions charts and scanned records.
- Provided excellent customer service while responsibly managing sensitive patient data in accordance with HIPAA guidelines.
- Obtained and organized medical records for office visits and scheduled labs.
- Managed unit resources effectively, ensuring optimal utilization of equipment and supplies.
- Supported clinical staff by ordering necessary supplies on time, ensuring adequate stock levels were maintained.
- Coordinated diagnostic tests, collection of samples and transportation to scanning rooms.
- Completed daily charge reconciliation to keep billing current and accurate.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
Emergency Department Clerk
Camden Clark Medical Center
07.2011 - 12.2013
- Supported medical staff in providing prompt care, coordinating necessary diagnostic tests and laboratory results.
- Utilized multiple PC applications throughout day.
- Collaborated with multidisciplinary teams to ensure comprehensive care for all emergency department patients.
- Enhanced patient satisfaction by efficiently managing check-in and registration processes.
Emergency Department Technician
Camden Clark Medical Center
07.2011 - 12.2013
- Assisted with resuscitation, CPR, and emergency airway procedures.
- Enhanced patient care by providing assistance to nurses and physicians during medical procedures.
- Assisted in obtaining and documenting vital signs and placement of oxygen saturation, cardiac monitoring, and non-invasive blood pressure monitoring systems.
- Participated in ongoing training programs to stay current on best practices in emergency medicine.
- Monitored vital signs of critical patients while alerting appropriate medical personnel when changes occurred.
- Worked with nurses to assess patients and prepare for tests and procedures.
- Received direction and assignments from physicians and nurses, providing efficient technical support to optimize patient care.
- Measured vital statistics, collected specimens for lab analysis and recorded data in appropriate medical records.
- Safely transported patients by wheelchair, stretcher, or bed to other units.
Cardiac Stress Technician
St Joseph Hospital
12.2007 - 07.2011
- Promoted a positive work environment by actively supporting colleagues and sharing expertise when appropriate.
- Exceeded quality assurance standards consistently through diligent adherence to established protocols.
- Utilized advanced imaging technologies skillfully for accurate assessment of cardiac function.
- Maintained a clean and organized workspace, ensuring the availability of necessary equipment for each procedure.
- Maintained and adjusted cardiology and pulmonary equipment.
- Conducted electrocardiogram, echocardiogram, phonocardiogram and stress tests by using electronic test equipment and recording devices.
- Utilized stethoscopes, thermometers and sphygmomanometers to meet patient needs and prescribed medical therapies.
EKG Technician
St Joseph Hospital
10.2005 - 12.2007
- Enhanced patient care by accurately performing EKG testing and analyzing results.
- Adhered to cleaning protocol for EKG machine, Holter cables and accessories to provide safe environment.
- Administered testing with electrocardiogram for patients experiencing events and as screening tool.
- Facilitated seamless transfer of data between departments by uploading completed EKG reports into electronic medical records systems accurately.
- Monitored patient activity during stress test to record data.
- Educated patients on testing and preparation steps prior to procedure.
- Provided instruction on Holter monitor and connected patient to analyzer.
Unit Clerk
St. Joseph Hospital
01.2003 - 10.2005
- Documented updates to patient information in medical charts while maintaining HIPAA compliance protecting confidentiality of records.
- Arranged discharges and patient transportations.
- Organized patient charts, enhancing the flow of information among healthcare providers and contributing to better-informed treatment decisions.
- Assisted nurses and physicians with patient care, improving overall quality of service provided to patients.
- Consistently met deadlines when completing tasks such as filing documents or inputting data into the hospital''s system.
- Expedited communication between healthcare professionals, resulting in better coordination of care for patients.
Education
No Degree - Secretarial Science/ Accounting
Parkersburg Community College
Parkersburg, WVSkills
- Prior authorization
- Insurance verification expertise
- Documentation management
- Effective communication
- HIPAA compliance
- Telephone etiquette
- Professionalism and ethics
- Resource information
- Strong communication skills
- Insurance verification expertise
- Teamwork orientation
Timeline
Authorization Specialist
Parkersburg Cardiology
08.2015 - Current
Insurance Verification Clerk
Parkersburg Cardiology
08.2015 - Current
Medical Records Clerk
Parkersburg Cardiology
08.2015 - 12.2018
Cardiology Tech
Camden Clark Medical Center
01.2013 - 08.2015
Unit Clerk
Camden Clark Medical Center
07.2011 - 08.2015
Emergency Department Clerk
Camden Clark Medical Center
07.2011 - 12.2013
Emergency Department Technician
Camden Clark Medical Center
07.2011 - 12.2013
Cardiac Stress Technician
St Joseph Hospital
12.2007 - 07.2011
EKG Technician
St Joseph Hospital
10.2005 - 12.2007
Unit Clerk
St. Joseph Hospital
01.2003 - 10.2005
No Degree - Secretarial Science/ Accounting
Parkersburg Community College
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