Susanna Roscoe
WILLIS,TX
Summary
Detail-oriented prior authorization specialist proudly offering several years' experience managing medical documents meticulously. Polished professional known for working closely with insurance companies to alleviate denied claims and obtain necessary prior approvals for services. Multitasks expertly in fast-paced environments.
Overview
15
15
years of professional experience
Work History
Remote Prior Authorization Specialist
River Kids Pediatric Home Health
Willis, TX
05.2024 - Current
- Facilitated communication between providers, payers and health plans regarding prior authorization processes.
- Interpreted benefit language in order to determine covered services under each plan type.
- Ensured compliance with state and federal regulations pertaining to prior authorizations.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Maintained accurate records of all authorization activities in the database system.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients.
- Input claim, prior authorization, and other important medical data into system.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
Prior Authorization Specialist
Aspire Hospital
Conroe, TX
04.2022 - 05.2024
- Review insurance coverage for patients to determine which party is liable for payment.
- Track referral submission during facilitation of prior authorization issuance.
- Verify eligibility and compliance with authorization requirements for service providers.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Obtain and log patient insurance and demographic information for use by insurance providers and medical personnel.
- Reach out to insurance carriers to obtain prior authorization for testing and procedures.
- Collected and processed patient liability statements prior to service.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Verified eligibility and compliance with authorization requirements for service providers.
Medical Office Assistant
CHI Baylor St. Luke's Medical Center
The Woodlands, TX
04.2012 - 04.2020
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Entered procedure codes and diagnosis codes into medical billing software.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
- Contacted patients regarding unpaid and underpaid accounts to resolve issues.
- Performed clerical duties, such as word processing, data entry, answering phones and filing.
- Efficiently performed insurance verifications, pre-certifications and pre-authorization functions.
Medical Receptionist
Mark Francis, MD
Houston, TX
05.2009 - 04.2012
- Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability.
- Checked patient data including insurance, demographic and health history to keep information current.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Managed multi-line phone system and pleasantly greeted patients.
- Responded to correspondence from insurance companies to verify patient's coverage.
- Maintained current and accurate medical records for patients.
- Completed patient referrals to other medical specialists.
- Enhanced office productivity by handling high volume of callers per day.
- Transcribed phone messages and relayed to appropriate personnel.
- Adhered to strict HIPAA guidelines to protect patient privacy.
Education
High School Diploma -
New Rochelle High School
New Rochelle, NY1983
Skills
- Patient Referrals
- Clear Communication
- Problem Anticipation and Resolution
- Patient Relations
- Critical Thinking
- Appointment Scheduling
- Multitasking and Prioritization
- Data Entry
- Conflict Resolution
- Medical Coding
- Coverage and Authorizations
- Prior Authorization Processing
- Patient Eligibility Requirements
- Precertification requirements
- EMR/EHR
Accomplishments
- Recognized for outstanding dedication to patient care.
- Scheduling - Communicated with patients through phone, fax, email and in person to schedule appointments and answer inquiries.
- Monetary Transactions - Handled cash, check, credit and automatic debit card transactions with 100% accuracy.
- Conflict Resolution - Responsible for handling customer account inquiries, accurately providing information to ensure resolution of product/service complaints and customer satisfaction
Languages
German
Native/ Bilingual
References
References available upon request.
Timeline
Remote Prior Authorization Specialist
River Kids Pediatric Home Health
05.2024 - Current
Prior Authorization Specialist
Aspire Hospital
04.2022 - 05.2024
Medical Office Assistant
CHI Baylor St. Luke's Medical Center
04.2012 - 04.2020
Medical Receptionist
Mark Francis, MD
05.2009 - 04.2012
High School Diploma -
New Rochelle High School
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