Sherry Akers
Roanoke,VA
Summary
Detail-oriented medical prior authorization specialist with over 25 years of experience in the medical field obtaining insurance authorizations, verifying benefits, and coordinating patient care. Skilled in reviewing medical documentation, submitting authorization requests, and communicating with insurance companies, physicians, and patients. Strong knowledge of medical terminology, CPT/HCPCS/ICD-10 coding, and healthcare regulations. Proven ability to manage high-volume workloads while maintaining accuracy and compliance.
Overview
20
20
years of professional experience
Work History
Authorization Specialist
Lewis Gale Medical Center
Salem, VA
07.2021 - Current
- Processed patient authorization requests efficiently and accurately.
- Communicated with healthcare providers to verify insurance information.
- Reviewed medical records to ensure compliance with authorization guidelines.
- Coordinated with billing department to resolve payment issues related to authorizations.
- Assisted in training new staff on authorization procedures and systems.
- Monitored changes in insurance policies affecting patient authorizations.
- Collaborated with clinical teams to facilitate timely patient care transitions.
- Researched patient eligibility, coverage information, and benefit levels.
- Performed data entry into various computer systems including but not limited to EMRs and CRMs.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Coordinated communication between providers, patients, payers, and other departments as needed.
- Reviewed authorization requests for accuracy and completeness.
- Monitored daily workflow queues within the department ensuring all tasks are completed accurately and timely.
- Provided customer service to internal and external customers related to authorization requests.
- Investigated discrepancies identified during audits of claims submitted for reimbursement by providers.
- Processed prior authorization requests in accordance with departmental guidelines.
- Created spreadsheets utilizing Microsoft Excel for tracking authorization status updates from payers.
- Generated monthly reports detailing productivity metrics such as number of authorizations processed per day, week, month.
- Conducted training sessions for new employees regarding company policies related to the authorization process.
- Ensured timely submission of accurate documentation to support payment of services rendered by providers.
- Assisted in the development of new processes and protocols to improve operational efficiency.
- Prepared appeal letters on behalf of clients when necessary to resolve disputes with insurers.
- Maintained current knowledge of applicable regulations, laws, and standards.
- Analyzed denials received from third party payers to identify trends in denials and develop proactive measures for resolution.
- Participated in meetings with staff members from other departments such as billing and coding teams to provide clarification on policies related to authorizations.
- Attended continuing education seminars on topics relevant to the role such as coding changes or insurance policy updates.
- Entered data into electronic medical record system accurately and efficiently.
- Managed intake of new claims and performed routine follow-ups.
- Explained reasons behind application denials and recommended further action.
- Coordinated with other departments to promote prompt processing of client applications.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Submitted delinquent accounts to collections department or outside resources.
- Kept detailed reports of client and account data, consistently updating database with latest information.
- Reviewed accounts for signs of fraud and non-payment issues.
Field Tech
CIOX
phoenix, AZ
01.2006 - 11.2020
- Conducted audits of medical documentation to ensure accuracy and completeness.
- Reviewed medical charts for compliance with regulatory standards and guidelines.
- Maintained detailed records of audit findings, ensuring accurate tracking of corrective actions.
- Utilized electronic health record systems to streamline auditing processes effectively.
- Adhered to HIPAA regulations when handling confidential patient information.
- Developed comprehensive reports on audit findings with actionable recommendations for management.
- Collaborated with department heads on initiatives aimed at improving overall quality assurance processes within the facility.
- Collaborated with healthcare teams to clarify charting inconsistencies and errors.
- Interacted with physicians, nurses, administrators, and other healthcare professionals regarding audit issues.
- Participated in meetings with hospital staff to discuss audit results and corrective action plans.
- Verified that all relevant documents were included in each chart.
- Compiled data from the medical records for analysis purposes.
- Provided technical assistance to staff regarding coding guidelines and best practices for clinical documentation.
- Analyzed data for potential areas where improvement may be needed in coding accuracy or completeness of documentation.
- Checked for compliance with applicable laws, regulations, and standards of practice.
- Identified discrepancies in medical records, such as missing or incorrect documentation.
- Provided targeted feedback to enhance the quality of care and streamline operational efficiency.
- Safeguarded medical records to maintain patient confidentiality.
Education
Bachelor of Science - Medical Management
Bluefield College
Bluefield, WV05-1992
High School Diploma -
Franklin County High School
Rocky Mount, VA06-1986
Skills
- Prior authorization
- Insurance verification
- Authorization processing
- Claims management
- Medical records analysis
- Medical coding
- Billing procedures
- Eligibility procedures
- Compliance review
- Healthcare regulations
- Regulatory compliance
- Quality assurance
- Documentation management
- Data entry proficiency
- Data entry accuracy
- Paperwork processing
- Process improvement
- Fraud detection
- Investigations
- Audit support
- Client assessment
- Patient advocacy
- Public assistance
- Income verification
- Policy compliance
- Policy interpretation
- Appointment scheduling
- Resource information
- Research skills
- Reporting documentation
- Record keeping
- Software proficiency
- Microsoft office
- Software knowledge
- Communication skills
- Effective communication
- Verbal communication
- Written communication
- Team collaboration
- Cross-functional teamwork
- Customer service
- Conflict resolution
- Problem solving
- Attention to detail
- Reliability
- Prioritization
- Interviewing
- Applicant engagement
- Applicant support
- Assistance eligibility
- Disability awareness
- Workflow optimization
- Confidentiality
- Process improvement
- Data input
- Application review
- Application assessment
- Healthcare regulations
- Healthcare compliance
- Process improvement
- Prior authorization
- Cross-functional teamwork
- [Software] expertise
- Workflow optimization
Timeline
Authorization Specialist
Lewis Gale Medical Center
07.2021 - Current
Field Tech
CIOX
01.2006 - 11.2020
Bachelor of Science - Medical Management
Bluefield College
High School Diploma -
Franklin County High School