Sonia Roby
Sterling Heights,MI
Summary
Manager Authorization / Referral Coordinator 16 years of billing and coding, patient charting, insurance claims and appointment scheduling in a busy medical office setting, poses a CHIT. Authorized to work in the US for any employer
Overview
18
18
years of professional experience
1
1
Certification
Work History
Authorization Specialist/Billing Specialist
Michigan Healthcare Professionals
03.2025 - Current
- Demonstrated adaptability with changing insurance requirements, maintaining up-to-date knowledge through continuous education efforts.
- Conducted regular audits of authorization records to verify accuracy and adherence to regulatory requirements, minimizing risk of noncompliance.
- Developed strong relationships with insurance representatives to expedite approvals and resolve issues promptly.
- Verify insurance eligibility and benefits to detect coverage changes or policy termination.
- Initiate and secure prior authorizations for chemotherapy, biologic agents and supportive care medications via payer portal. Communicate with Oncologist, Nurses staff to review histories, diagnosis, treatment plans. Ensure clinical documentation supports the medical necessity requirements ( NCCN guidelines of the payer .
- Contact payer to extend expired authorization and renewals
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Verify all required payer documentation and authorizations is recorded and uploaded to the Electronia Medical Records ( EMR).
- Ensured prompt resolution of denied claims through comprehensive analysis of denial reasons and timely submission of necessary for reconsideration or appeal.
Admission Director
SKLD BLOOMFIELD HILLS
04.2024 - 03.2025
- Understanding of different types of insurance, knowledge of medical terminology, and experience with Electronic Medical Records (EMR)
- Verifies patient's insurance, billing, Utilization review.
- Understand and anticipate what a guest may need and exceed expectations.
- Greet patients upon arrival, assign rooms, take inventory of personal items and obtain and complete admission contracts.
- Are you proficient in Microsoft Office and PowerPoint
- Act as a liaison between the facility and the outside community.
- Connect daily with potential referral sources including hospitals, physicians, insurers, case management companies and health care agencies.
- Create and execute facility sales and marketing plans and strategies.
- Conduct facility tours for potential residents and families.
- Conduct admission screening of potential patients; determine the level of care, services required, equipment needs and insurance coverage, as indicated.
- Welcome resident and family on admission.
- Knowledge of or ability reimbursement programs
- Communicate professionally and effectively with residents, their family members, referral sources and all levels of the organization both orally and in written form
- Strong organizational skills
- Skilled at making presentations/public speaking. Assists with the implementation of the marketing strategy through participating in some external marketing to discuss the facilities in the local community.
- Assist facility Administrator and department heads with daily operations.
- Communicates and interacts effectively and tactfully with Residents, visitors, families and coworkers.
- Maintains a high level of confidentiality in accordance with HIPAA guidelines at all times and protects confidential information by only providing information on a “need-to-know” basis.
- Attends in-service and education programs and attends continuing education required for maintenance of professional certification or licensure (if applicable).
- Understands Infection Control and follows the Company’s Infection Control guidelines, such as hand washing principles, understanding of isolation and standard precautions, recognizing signs and symptoms of infection, demonstrating and understanding of the process for identifying and handling infectious waste and cross contamination, maintaining personal hygiene, and complying with OSHA standards in the workplace.
- Promotes and Protects Patient Rights by assisting Residents to make informed decisions, treating Residents with dignity and respect, protecting Residents’ personal belongings, reporting suspected abuse or neglect, avoiding the need for physical restraints in accordance with current professional standards, and supporting independent expression, choice and decision-making consistent with applicable laws and regulations.
- Regular and reliable attendance.
- Perform other tasks as required.
- Bridge communication with physician offices, management teams, residents, and their families to ensure ongoing patient satisfaction
- Provides customers with facility-related information via, personal visits/ assessments, presentations, facility tours, and follow-up
- Reviews all new referrals for facility appropriateness, including reviewing medical, financial, and other records with the appropriate department heads.
- Responds to all referrals within a 15-minute time frame.
- Identifies and verifies payor source.
- Completes and updates data entry within CRM for all incoming residents.
- Provides appropriate staff with fast-track information for all new and returning residents.
- Responds to inquiries from hospital discharge planners, families, and other referral sources
- Manages the inquiry process professionally, timely and with appropriate follow-up
- Manages the admission process by maintaining updated bed availability and facility services information
- Contacts/community resources along with knowledge of industry trends and legislative/regulatory issues and communicates this information to facility staff and community contacts
- Develops and implements special events and presentations targeted at community education, establishing, and maintaining status for the facility as the expert on skilled nursing, specialty programs, and rehabilitation care in the community
- Monitors and evaluates customer satisfaction with current and former patients, their families, and referral sources and shares results with the management team and others as appropriate to develop action plans as needed.
Referral Coordinator/Utilization Review Specialist (Contract)
American Oncology Network
01.2023 - 03.2024
- Allscript /Athena/Centritry/CernerContacting various 3rd party payer insurance carriers to initiate and obtaining authorization Oncology IV medications and verifying treatment plans ordered by Oncologist
- Review medical history, diagnosis, and treatment plans. Ensure clinical documentation supports the medical necessity requirements (NCCN guidelines) of the payer
- Verify insurance eligibility and benefits to detect coverage .
- Review patient insurances and documentation through EMR system
- Updating patient charts/records
- Updating audit reports
- Answering phones
- Scanning documents into patient charts
- Other duties as assigned
- EPIC
- Follow up on denials
- Responded to patient inquiries to offer timely updates regarding referral status.
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
Manager Referral Authorization Coordinator
Children's Hospital Detroit Michigan
04.2008 - 01.2023
- Coordinate and manage care services for clients in the designated market
- All scripts Review/Release bill holds/manages bill hold list in Link (PC/RE bill holds) Request and initiate authorizations from various third-party payors. Radiology Oncology, Musculoskeletal, Neurosurgery
- Validates discharge status (inpatient vs. observation) matches physician's order.
- Appropriate authorizations from respective payors.
- Cross-trained existing employees to maximize team agility and performance.
- Required authorization from 3 party payors, Upload and document au in EPIC, Allscipt.
- Assists case managers, social workers, ordering DME, discharge placement coordinators and nursing staff to ensure acute care placement, length of stay and level of service are appropriate.
- Verifies third party-payors eligibility verifies demographics.
- Completes requisitions and purchase orders.
- Review Inpatient and Observation list to make sure orders are correct for current patient in-house.
- Send discrepancies to CCS for corrections Retrieve authorization letters or denial letters enter into Allscripts and Link.
- Follow up on denials.
- Notify URS via task in Athena/ Allscripts, EPIC Athena, CentralReach.
- Perform payroll/scheduling, along with other clerical duties.
- Answered and quickly redirected up to 20 calls per hour.
- Planned and coordinated logistics and materials for board meetings, committee meetings and staff events.
- Follow up on Homecare DME order
- Schedule patience appointments
- Pay role
- Interviewing hiring staff
- Created detailed expense reports and requests for capital expenditures.
- Ordered and distributed office supplies while adhering to a fixed office budget.
- Accomplished multiple tasks within established timeframes.
- Managed and motivated employees to be productive and engaged in work.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Streamlined workflows by identifying bottlenecks in existing systems and implementing appropriate solutions.
Education
Associate's degree - Health Information Technology
Wayne County Community College
Detroit, MI01.2011
High school diploma or GED - undefined
Continental Academy
Miramar, FL06.2000
Certificate - Medical Assisting/ Certified Nurse Assistant
Dearborn Medical
Dearborn, MI08.1998
Skills
- Healthcare billing
- Microsoft Office
- Clinic
- Microsoft Powerpoint
- Allscripts
- Anatomy knowledge
- Accounts receivable
- Payroll
- Bookkeeping
- Clerical experience
- NetSuite
- Accounting software
- Administrative experience
- ICD-10
- Word processing
- Medical terminology
- Office management
- Microsoft Word
- Cardiology
- Accounts payable
- DATABASE (8 years)
- CLERICAL (8 years)
- Customer service (10 years)
- Human resources
- Records management
- CUSTOMER SERVICE (10 years)
- Medical office management
- HIPAA
- Conflict management
- Medical office experience
- Phone etiquette
- Insurance verification
- Medicare
- BILLING (6 years)
- Medical Records
- EMR systems
- Microsoft Excel
- ARTICULATE (Less than 1 year)
- Plastic surgery
- Accounting
- Front desk
- Outpatient
- Time management
- Athena/Allscript (10 years)
- CPT coding
- Leadership
- Computer skills
- Medical coding
- ICD-9
- Documentation review
Certification
- BLS Certification January 2024 to Present
- RHIT
- Certified Coding Associate
- ACLS Certification
- RHIA
- AHIMA
- Driver's License
- CNA March 2022 to July 2026
- CPR Certification January 2024 to January 2026
- Certified Medical Assistant April 2023 to April 2025
- Medical Billing Certification January 2023 to April 2025
- RPSGT
- Certified Phlebotomy Technician
- CCMA Certification
- Certified Coding Specialist
- RMA
- Professional In Human Resources
- Certified Professional Coder
- Fundamental Payroll Certification
- SHRM Certified Professional
Timeline
Authorization Specialist/Billing Specialist
Michigan Healthcare Professionals
03.2025 - Current
Admission Director
SKLD BLOOMFIELD HILLS
04.2024 - 03.2025
Referral Coordinator/Utilization Review Specialist (Contract)
American Oncology Network
01.2023 - 03.2024
Manager Referral Authorization Coordinator
Children's Hospital Detroit Michigan
04.2008 - 01.2023
High school diploma or GED - undefined
Continental Academy
Certificate - Medical Assisting/ Certified Nurse Assistant
Dearborn Medical
Associate's degree - Health Information Technology
Wayne County Community College
Additional Information
- SKILLS
- Professional phone etiquette
- Appointment setting Excellent communication skills
- Mainframe/Liasion Database management
- Advanced clerical knowledge Articulate and well-spoken
- Certified Nurse Assistant
- Certified Medical Office Assistant Customer service-oriented
- Medical Billing Excellent planner and coordinator
- Conference planning Works well under pressure
- Spreadsheet management Allscript
- HIPAA compliance Critical thinker