Smitha saha
Lead Authorization Specialist
McKinney,TX
Summary
Experienced and Hardworking Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for Skilled Services. Considered team player with exemplary multitasking skills. Brings proven track record of success in determining eligibility and resolving complex cases. Works professionally with clients to develop and implement successful strategies for maximizing services and benefits. Skilled in problem-solving and identifying solutions meeting clients' needs.
Detail-oriented performer with experience of managing documentation, experienced in billing review, fraud detection and administrative assistant, leading to accomplish organization goals independently.
Overview
5
5
years of professional experience
Work History
authorization specialist
Connect America
10.2021 - Current
- Researched denied claims and contacted insurance companies to resolve these issues.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Verified eligibility and compliance with authorization requirements for service providers.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Coordinated with contracting department to resolve payer issues.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified eligibility and Submit of authorization to the insurance plan.
- Coordinated all follow-up phone calls to the insurance company for status of authorization or to request for additional information.
Prior Authorization specialist
Empress Healthcare services
11.2020 - 09.2021
- Obtained initial and subsequent authorization as needed for assigned location(s)/payer(s).
- Performed insurance verification and submits/tracks single case agreements as necessary.
- Documented ongoing communication with payer case managers for updates/changes/authorizations.
- Handled patient complaints in a fair and empathetic manner
- Maintained confidentiality of patient information.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Demonstrated ability to work effectively and maintains expected productivity
- Demonstrated handling EHR system(Home Care Home Base) with utmost efficiency.
Prior Authorization specialist
one point home health
01.2020 - 10.2020
- Inserted and updated all patient data regarding claims and prior authorizations into system accurately
- Reached out to insurance carriers to obtain prior authorization for home health skilled services
- Tracked referral submission during facilitation of prior authorization issuance
- Created and maintained spreadsheets detailing all skilled services including applicable denials and approvals
- Verified eligibility and compliance with authorization requirements for service providers
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel
- Resolved problems, improved operations and provided exceptional client support
- Maintained excellent attendance record, consistently arriving to work on time.
Independent Reatil business owner
bengal Bar and grill llc
03.2019 - 11.2019
- Worked with customers to understand needs and provide service
- Sold minimum number of products based on goals and objectives defined by sales metrics Coordinating with webmaster to update the website and create Internet promotions and advertisements Disclosing terms of sales with vendors and reviewing inventory replenishment Preparing sold products for customer delivery prior to shipping, ensuring that the customer receives quality products in a timely manner Establish or identify prices of goods and services and tabulate the bills
- Performed retail transactions, Money management and product responsibility with efficiency and accuracy.
Education
Bachelor of Science - Mathematics Honors
Vidyasagar University
Skills
Effective communication skills
Proficiency in Medical terminology
Physician order verificationCustomer serviceExtensive Knowledge in Data Analysis
Problem resolutionTeam managementProficiency in Hsys Electronic Billing Software for Medicaid
Proficiency in Salesforce CRM software
OnBase Record Management softwareProficiency in Home Care Home Base - (ERP)
Proficiency in Microsoft Office – Word, Excel and PowerPoint
Proficiency in Kinnser - (EMR Software)
Timeline
authorization specialist
Connect America
10.2021 - Current
Prior Authorization specialist
Empress Healthcare services
11.2020 - 09.2021
Prior Authorization specialist
one point home health
01.2020 - 10.2020
Independent Reatil business owner
bengal Bar and grill llc
03.2019 - 11.2019
Bachelor of Science - Mathematics Honors
Vidyasagar University