Teresa Woods
Humble,TX
Summary
Dependable Prior Authorization Specialist with a career spent handling various administrative responsibilities in fast-paced settings. Well-trained in Oncology/Rheumatology with dedication to continuously enhancing strategies and optimizing assistance. Highly organized and hardworking with strong attention to detail. Ready to tackle new challenges in an office-based environment.
Overview
9
9
years of professional experience
Work History
Prior Authorization Specialist/Insurance Verification Specialist
Millennium Physicians Oncology/Rheumatology
Kingwood, TX
12.2018 - Current
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Processed appeals in a timely manner as per policy guidelines.
- 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.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Notified ordering providers of denied authorizations.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Facilitated communication between providers, payers and health plans regarding prior authorization processes.
- Ensured compliance with state and federal regulations pertaining to prior authorizations.
- Responded promptly to customer inquiries regarding their benefits and eligibility status.
- Maintained positive working relationship with fellow staff and management.
Insurance Verification Specialist
AcariaHealth Specialty Pharmacy/Oncology
Houston, TX
05.2015 - 12.2018
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Processed appeals in a timely manner as per policy guidelines.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Updated patient and insurance data and input changes into company computer system.
Pharmacy Technician
Harris Health Ben Taub Hospital
Houston, TX
2013 - 2015
- Prepared medications for dispensing by counting, pouring, labeling, and verifying doses.
- Performed data entry for patient profiles, billing information and prescription orders into the pharmacy software system.
- Retrieved medication from shelves based on physician orders and delivered them to pharmacists for review.
- Ensured compliance with all federal, state, local laws and company policies related to pharmacy operations.
- Resolved customer complaints in a timely manner while maintaining professionalism at all times.
- Checked expiration dates on medications to ensure that only unexpired products were dispensed.
- Restocked shelves with new supplies of medications as needed.
- Answered telephones to respond to questions or requests.
- Entered prescription information into computer databases.
- Operated cash registers to accept payments from customers.
Supervisor/Head Pharmacy Technician
Northwest Pharmacy Svc
Houston, TX
2001 - 2013
- Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions.
- Developed and implemented operational policies and procedures to ensure efficiency and accuracy of workflows.
- Resolved customer complaints in a timely manner while ensuring customer satisfaction.
- Performed monthly inventory checks to ensure sufficient stock levels for all products.
- Ensured compliance with workplace safety regulations by providing training sessions for all staff members.
- Evaluated employee performance through periodic reviews and documented results accordingly.
- Monitored employee productivity to provide constructive feedback and coaching.
- Identified needs of customers promptly and efficiently.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Maintained accurate records of medications dispensed, including dosage and quantity.
- Ordered pharmaceuticals from wholesalers and suppliers as needed.
- Stocked shelves with prescription medications, over-the-counter products, vitamins, supplements.
- Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
- Efficiently processed cash register transactions for new and refilled prescription orders.
Pharmacy Technician
Harris Health System - Ben Taub General Hospital
Houston, TX
1994 - 2001
- Performed data entry for patient profiles, billing information and prescription orders into the pharmacy software system.
- Managed filing of prescriptions, both electronically and manually.
- Retrieved medication from shelves based on physician orders and delivered them to pharmacists for review.
- Checked expiration dates on medications to ensure that only unexpired products were dispensed.
- Reported any discrepancies or errors in medication ordering or filling processes immediately to the pharmacist on duty.
- Kept accurate records of controlled substances received and dispensed in accordance with DEA regulations.
- Organized work areas so that everything was easily accessible when needed.
- Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
- Verified prescriptions and drug labels, documents and packages.
- Received written prescription or refill requests, verifying information for completeness and accuracy.
Education
High School Diploma -
Carver High School For Applied Tech/Engineering/Arts
Houston, TX03-1987
Skills
- Insurance Verification
- Effective Communication Skills
- Insurance Procedures
- Precertification Requirements
Timeline
Prior Authorization Specialist/Insurance Verification Specialist
Millennium Physicians Oncology/Rheumatology
12.2018 - Current
Insurance Verification Specialist
AcariaHealth Specialty Pharmacy/Oncology
05.2015 - 12.2018
Pharmacy Technician
Harris Health Ben Taub Hospital
2013 - 2015
Supervisor/Head Pharmacy Technician
Northwest Pharmacy Svc
2001 - 2013
Pharmacy Technician
Harris Health System - Ben Taub General Hospital
1994 - 2001
High School Diploma -
Carver High School For Applied Tech/Engineering/Arts
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