Sunya Moore
Pittsburgh,PA
Summary
Dedicated and empathetic Medical Assistant offering experience in direct patient care and medical office management experience. Committed to obtaining highest level of patient satisfaction. Dedicated to complying with regulatory and practice standards. Cultivates trust and rapport with patients through excellent communication and interpersonal skills.
Overview
22
22
years of professional experience
Work History
Authorization Specialist
UPMC Magee Women's Hospital
Pittsburgh, PA
04.2023 - Current
- Processed prior authorization requests in accordance with departmental guidelines.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Assisted in the development of new processes and protocols to improve operational efficiency.
- Tracked authorization statuses using electronic databases or manual filing systems.
- Prepared appeal letters on behalf of clients when necessary to resolve disputes with insurers.
- Ensured timely submission of accurate documentation to support payment of services rendered by providers.
Healthcare Concierge (Part-time)
UPMC Health Plan
Pittsburgh, PA
04.2018 - 06.2024
- Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
- Answered incoming calls and provided highest level of professionalism and knowledgeable service to every customer.
- Managed customer expectations by clarifying needs, identifying options and recommending products and services.
- Documented customer correspondence in CRM to track requests, problems and solutions.
- Answered, screened and processed high volume of calls daily with call management system and web-based communications.
Care Team Coodinator
Absolute Care
Pittsburgh, PA
12.2022 - 04.2023
- Performed preliminary physical tests to accurately record results in patient history summary.
- Scheduled appointments for patients via phone and in person.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
- Educated patients about medications, procedures and physician's instructions.
- Conducted insurance verification and pre-certification and pre-authorization functions.
- Assisted with diagnostic testing by collecting and packaging biological specimens for internal and laboratory analysis.
- Followed principles of asepsis and infection control to meet patient safety guidelines.
- Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
- Documented notes during patient visits.
- Administered rapid tests for COVID and strep to help clinical staff assess conditions.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Processed prior authorization requests in accordance with departmental guidelines.
- Coordinated communication between providers, patients, payers, and other departments as needed.
- Prepared appeal letters on behalf of clients when necessary to resolve disputes with insurers.
Patient Access Supervisor
Metro Community Health Center
Pittsburgh, PA
01.2020 - 10.2022
- Applied HIPAA privacy and security regulations while handling patient information.
- Verified demographics and insurance information to register patients in computer system.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
- Obtained necessary signatures for privacy laws and consent for treatment.
- Assembled registration paperwork and placed identification bands on patient.
- Applied knowledge of payer requirements and utilized on-line eligibility systems to verify patient coverage and policy limitations.
- Processed patient responsibility estimate determined by insurance at pre-registration.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Communicated financial obligations to patients and collected fees at time of service.
- Registered patients by completing face-to-face interviews to obtain demographic, insurance and medical information.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Recruited, hired and trained new medical and facility staff.
- Built work schedules and staff assignments, taking workload, space and equipment availability into consideration.
- Assessed need for additional staff, equipment and services based on historical data and seasonal trends.
Prior Authorization Specialist
Metro Community Health Center
Pittsburgh, PA
07.2015 - 01.2020
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Notified ordering providers of denied authorizations.
- Coordinated resolutions for issues and appealed denied authorizations.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
- Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
Medical Assistant
Metro Community Health Center
Pittsburgh, PA
04.2014 - 07.2015
- Prepared treatment rooms for patients by cleaning surfaces and restocking supplies.
- Interviewed and engaged patients to obtain medical history, chief complaints and vital signs.
- Organized charts, documents and supplies to maintain team productivity.
- Contacted pharmacies to submit and refill patients' prescriptions.
- Educated patients about medications, procedures and physician's instructions.
- Maintained inventory, vaccination and product expiration logs to record updated documentation for tracking purposes.
- Assisted with diagnostic testing by collecting and packaging biological specimens for internal and laboratory analysis.
- Documented notes during patient visits.
Medical Assistant
Primary Care Northside
Pittsburgh, PA
01.2009 - 03.2014
- Scheduled appointments for patients via phone and in person.
- Prepared treatment rooms for patients by cleaning surfaces and restocking supplies.
- Educated patients about medications, procedures and physician's instructions.
- Organized charts, documents and supplies to maintain team productivity.
- Contacted pharmacies to submit and refill patients' prescriptions.
- Assessed, documented and monitored vital signs for patients within outpatient setting.
- Conducted insurance verification and pre-certification and pre-authorization functions.
- Assisted with diagnostic testing by collecting and packaging biological specimens for internal and laboratory analysis.
- Followed principles of asepsis and infection control to meet patient safety guidelines.
- Documented notes during patient visits.
- Labeled and completed lab requisitions using ICD and CPT coding.
- Measured vital signs and took medical histories to prepare patients for examination.
Medical Assistant Instructor
Sanford Brown Institute
Pittsburgh, PA
05.2009 - 01.2010
- Created homework assignments and handouts applicable to classroom lesson plans.
- Helped students develop technical and soft skills necessary for successful medical assistant work.
- Guided and mentored students to fully develop abilities and knowledge outlined in course plans.
- Assessed students' knowledge and skills through assignments and exams.
- Held clinical simulation projects and provided each student with individual feedback.
Medical Assistant
West Penn Family Practice
Pittsburgh, PA
09.2002 - 04.2009
- Interviewed and engaged patients to obtain medical history, chief complaints and vital signs.
- Prepared treatment rooms for patients by cleaning surfaces and restocking supplies.
- Organized charts, documents and supplies to maintain team productivity.
- Assisted with diagnostic testing by collecting and packaging biological specimens for internal and laboratory analysis.
- Labeled and completed lab requisitions using ICD and CPT coding.
- Measured vital signs and took medical histories to prepare patients for examination.
- Incorporated outside records into charts and EHR.
- Cleaned and maintained medical equipment following procedures and standards.
Education
Associate of Science - Clinical Administration/Medical Assistant
Sawyer School of Pittsburgh
Pittsburgh, PA11.1993
Skills
- Insurance company knowledgeable
- Regulatory compliance
- Payment processing
- Schedule management
- Appointment scheduling
- Health information systems
- Personnel management
- Records maintenance
- Staff supervision
- Performance metrics
- Wound care and irrigation
- Grooming and bathing assistance
- Medical billing
- Understands medical procedures
- Venipuncture and phlebotomy
- Proper sterilization techniques
- HIPAA compliance
- Lab equipment calibration
- Using a scale
- EKG set up and monitoring
- Vital sign monitors
- Call Center Operations
- Inbound and Outbound Calling
- Injections
- Vision acuity
- Dressing changes
- Piccolo machine operation
- Specimens collection and processing
- Sterile technique
- Insurance Verification
- HIPAA Compliance
- Medical terminology expertise
- Proficiency in Mircrosoft
- Documentation And Reporting
Timeline
Authorization Specialist
UPMC Magee Women's Hospital
04.2023 - Current
Care Team Coodinator
Absolute Care
12.2022 - 04.2023
Patient Access Supervisor
Metro Community Health Center
01.2020 - 10.2022
Healthcare Concierge (Part-time)
UPMC Health Plan
04.2018 - 06.2024
Prior Authorization Specialist
Metro Community Health Center
07.2015 - 01.2020
Medical Assistant
Metro Community Health Center
04.2014 - 07.2015
Medical Assistant Instructor
Sanford Brown Institute
05.2009 - 01.2010
Medical Assistant
Primary Care Northside
01.2009 - 03.2014
Medical Assistant
West Penn Family Practice
09.2002 - 04.2009
Associate of Science - Clinical Administration/Medical Assistant
Sawyer School of Pittsburgh
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