Sheri Neil

Prior Authorization Representative/Medical Biller and Coder

PharMerica

02.2015 - Current

Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
Verified eligibility and compliance with authorization requirements for service providers.
Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
Improved patient satisfaction by efficiently processing prior authorization requests and ensuring timely responses.
Streamlined workflow for faster approval turnaround times, handling high volume of insurance verification tasks.
Collaborated with healthcare providers to expedite the process of obtaining necessary medical documentation for approvals.
Reduced claim denials by thoroughly reviewing and analyzing medical necessity documentation before submitting for approval, ensuring all criteria were met.
Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
Contributed to departmental success by consistently meeting or exceeding performance metrics such as accuracy, productivity, and quality standards.
Facilitated better communication between departments through proactive engagement with other teams involved in the prior authorization process.
Contacted insurance companies to obtain prior authorization for medications.
Contacted insurance companies to obtain prior authorization for medical procedures and medications.
Achieved high customer satisfaction ratings by providing timely updates to patients and healthcare providers on the status of their requests.
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.
Reviewed patient charts to better understand health histories, diagnoses, and treatments.
Supported continuous improvement initiatives by actively participating in meetings, providing feedback, and suggesting areas for improvement.
Developed strong relationships with key stakeholders such as physicians, nurses, pharmacists, and office managers to support seamless coordination during the prior authorization process.
Responded to inquiries from healthcare providers regarding prior authorization requests.
Developed and maintained productive working relationships with healthcare providers.
Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
Utilized electronic medical record systems to store, retrieve and process patient data.
Scanned and uploaded medical records into electronic medical records system.
Communicated effectively with staff, patients, and insurance companies by email and telephone.