TONYA REDDEMAN
Fruitport
Summary
Professional in healthcare industry with strong background in managing authorizations and ensuring compliance. Skilled in navigating complex systems, problem-solving, and maintaining accurate records. Known for effective collaboration, adaptability, and delivering results in fast-paced environments. Reliable team player with expertise in healthcare regulations, communication, and customer service.
Overview
18
18
years of professional experience
Work History
Authorization Specialist
Orthopedic Associates of Muskegon
Muskegon, MI
08.2024 - 07.2026
- Streamlined review and processing of patient authorization requests for high-tech, injections and surgeries.
- Facilitated collaboration with healthcare providers to uphold insurance compliance standards.
- Oversaw maintenance of accurate records for authorization statuses within electronic systems.
- Assisted in training new staff on authorization processes and protocols.
- Streamlined workflows to reduce turnaround time for authorizations.
- Analyzed denial trends to develop strategies for improving approval rates.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- 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.
- Prevented delays in care delivery by proactively identifying potential issues during the pre-authorization process and seeking clarification from providers when needed.
Authorization Specialist
Michigan Pain Consultants
Muskegon, MI
09.2008 - 07.2024
- Facilitated processing of outgoing referrals to ensure timely client transitions.
- Executed processing of outgoing diagnostic testing to ensure timely delivery.
- Assisted with member and provider administrative tasks, including benefit verification and obtaining authorizations.
Supported management of authorization processes to facilitate efficient service delivery. - Oversaw review, submission, monitoring, and resolution of authorization requests.
- Conducted comprehensive reviews of clinical documentation to ensure compliance with medical guidelines before authorization request submission.
- Facilitated peer-to-peer coordination to enhance collaboration and efficiency.
- Oversaw monitoring of in-basket emails and fax server operations.
- Managed incoming patient calls and coordinated office operations.
- Oversaw high volume of cases, ensuring meticulous attention to detail and adherence to strict deadlines.
- Managed confidential client information while ensuring compliance with privacy laws and organizational guidelines.
Education
Certification - Medical Billing and Coding
Ross Medical
Grand Rapids, MI01-2008
Diploma - Business
New Lothrop High School
New Lothrop, MI06-1996
Skills
- Skilled in EPIC, ATHENA, and CENTRICITY EMR Systems
- Prior Authorization Processing
- Professionalism
- Proficient in medical terminology
- Insurance eligibility verification
- Data entry proficiency
- HIPAA compliance
- Effective utilization management
- Insurance Verification
- Empathy and Compassion
- Effective Communication skills
- Medical Terminology
- ICD-10
- Documentation Review
- Medical Records
- Medical Scheduling
Timeline
Authorization Specialist
Orthopedic Associates of Muskegon
08.2024 - 07.2026
Authorization Specialist
Michigan Pain Consultants
09.2008 - 07.2024
Diploma - Business
New Lothrop High School
Certification - Medical Billing and Coding
Ross Medical