- English
Suzi Hughes
Youngstown,OH
Summary
Dynamic healthcare professional with extensive expertise in authorization management and compliance, recognized for delivering timely and accurate authorizations while cultivating strong communication with interdisciplinary teams. Proven track record in driving collaborative efforts and achieving organizational objectives, consistently focused on enhancing operational efficiency. Highly skilled in problem-solving and adaptable to evolving industry demands, ensuring seamless workflows and strict adherence to regulatory standards. Authorized to work in the U.S. for any employer and ready to contribute effectively to a forward-thinking organization.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Revenue Cycle & Authorization Specialist
Rotech Healthcare Inc.
Remote
11.2022 - 12.2025
- Reviewed and processed authorization requests for medical services, ensuring compliance with policies.
- Analyzed claims data to identify trends and improve approval processes.
- Collaborated with healthcare providers to resolve discrepancies in authorization submissions.
- Led initiatives to reduce turnaround times for authorization approvals through process optimization.
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during the authorization process.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Demonstrated adaptability with changing insurance requirements, maintaining up-to-date knowledge through continuous education efforts.
- Ensured prompt resolution of denied claims through comprehensive analysis of denial reasons and timely submission of necessary documentation for reconsideration or appeal.
- Developed strong relationships with insurance representatives to expedite approvals and resolve issues promptly.
- Expedited claim processing by submitting complete and accurate information in accordance with payer requirements.
- Improved patient satisfaction by streamlining authorization processes and ensuring timely responses to inquiries.
- Resolved discrepancies with client applications to verify eligibility.
- Processed and certified documents for accuracy and compliance with government regulations.
- Analyzed patient accounts to identify billing discrepancies and ensure accurate revenue capture.
- Collaborated with clinical staff to streamline charge entry processes and reduce errors.
- Managed appeals process for denied claims, achieving successful overturn rates through thorough documentation review.
- Increased revenue by identifying and resolving billing errors in a timely manner.
- Enhanced customer satisfaction by promptly addressing and resolving billing disputes.
- Ensured accurate billing with thorough audits of patient accounts and insurance claims.
- Reached out to insurance companies to verify coverage.
- Achieved optimal reimbursement rates by verifying insurance coverage, eligibility, benefits, and authorization prior to service delivery.
- Streamlined the revenue cycle process for improved efficiency and faster payment collection.
- Provided regular updates on billing status to upper management through detailed reports.
- Maintained clear documentation of all activities related to unpaid claims or denied services.
- Improved cash flow with diligent follow-up on pending claims and appeals processes.
- Reduced turnaround time for claim submissions, ensuring compliance with healthcare regulations through diligent documentation.
- Facilitated seamless integration of electronic health records with billing software, enhancing accuracy of charge capture.
- Reduced errors and rejections by conducting thorough audits of medical records and claims data.
- Enhanced patient experience by maintaining accurate and up-to-date medical records.
- Updated patient and office medical records to comply with company and regulatory standards.
- Coordinated CPAP equipment orders and inventory management for optimal patient care.
Revenue Cycle & Authorization Specialist
MVI HomeCare
Remote
01.2022 - 11.2022
- Increased efficiency in documentation practices by utilizing electronic medical records systems effectively while maintaining patient confidentiality.
- Utilized electronic medical records to streamline patient data management, reducing errors in billing.
- Handled insurance verification tasks using Availity and Waystar to validate patient insurance information.
- Streamlined insurance verification processes, minimizing billing errors and improving revenue cycle management.
- Improved accuracy of medical billing by reviewing patient records and conducting regular audits.
- Contacted insurance companies for patient medical billing operations.
- Promoted accuracy in coding practices, staying current on ICD-10 changes and industry updates related to medical billing requirements.
- Improved accuracy of medical billing by meticulously verifying procedure codes before submitting claims to insurance companies.
- Provided medical billing and coding duties.
- Reduced error rates in medical billing by maintaining thorough knowledge of insurance regulations and guidelines.
- Maintained compliance with federal regulations by keeping current on changes in the healthcare industry affecting medical billing practices.
Veterinary Assistant/Receptionist
Niles Veterinary Clinic
Niles, OH
08.2015 - 01.2022
- Assisted veterinarians during examinations and procedures, ensuring animal comfort and safety.
- Prepared surgical instruments and maintained sterile environments for operations.
- Educated pet owners on proper care, nutrition, and preventative health measures.
- Administered medications and vaccinations as directed by veterinary staff.
- Coordinated scheduling for appointments, surgeries, and follow-up visits to optimize workflow.
- Trained new team members on clinic protocols and customer service standards.
- Enhanced patient care by assisting veterinarians with examinations, surgeries, and diagnostic procedures.
- Provided compassionate care for animals during treatment and recovery from illnesses or injuries.
- Ensured accuracy of medical records by diligently documenting all relevant information for each patient visit.
- Improved client relations through effective communication and education on pet health needs.
- Provided customer support to clients, answering questions and addressing concerns.
- Recorded symptoms and documented medical observations to inform treatment decisions.
- Reduced stress for patients with calming techniques during exams and procedures, creating a positive experience.
- Assisted in emergency situations effectively providing first aid or life-saving measures under veterinarian supervision.
- Increased client satisfaction by addressing concerns, answering questions, and offering valuable recommendations for pet care.
- Assisted with euthanasia procedures in humanely and compassionately to minimize suffering.
- Processed new patients and updated client records with key information using standardized registration systems and encrypted databases.
- Promoted preventive care services by educating clients on the importance of routine check-ups, vaccinations, and dental cleanings.
- Provided care for animals before surgeries, administering anesthetics as necessary for overall comfort and health.
- Participated continuing education training seminars workshops conferences advance knowledge stay current industry trends best practices.
- Encouraged preventive care, increasing number of pets receiving timely vaccinations and health screenings.
- Prepared animals for surgery, including pre-operative care and post-operative monitoring.
- Maintained medical records and documentation accurately, recording patient histories and treatment plans.
- Increased effectiveness of pet owner communications, providing clear instructions for at-home care and medication administration.
Education
Associate of Science - College Degree
01-2027
Associate of Arts - College Degree
05-2016
High School Diploma -
06.2007
- National Honor Society Member
Skills
- Medical terminology for both human and veterinary medicine
- Claims review & management
- Insurance eligibility & verification
- HIPAA compliance
- Microsoft office
- Proficiency in Epic, EIntake, Forcura, Wellsky
- Authorizations (including appeals & denial management)
- Medical billing expertise
- Accounts receivable management
- Audit support
- Type up to 200 words-per-minute
- Proficient in PetPoint, Avimark
- Veterinary standards and procedures
Accomplishments
- Fear Free Elite certification
- Animal CPR/First Aid certification
Certification
- Veterinary First Aid & CPR
- Fear Free Elite certified
Languages
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Interests
Painting
Reading
Cerebellar Hypoplasia awareness
Handicapped Pets Foundation awareness
Timeline
Revenue Cycle & Authorization Specialist - Rotech Healthcare Inc.
11.2022 - 12.2025
Revenue Cycle & Authorization Specialist - MVI HomeCare
01.2022 - 11.2022
Veterinary Assistant/Receptionist - Niles Veterinary Clinic
08.2015 - 01.2022
Ashworth College - Associate of Science, College Degree
Youngstown State University - Associate of Arts, College Degree
Cardinal Mooney - High School Diploma,