Summary
Overview
Work History
Education
Skills
Timeline
Generic

Tracy Harper

Dallas,TX

Summary

Accomplished managed care operations professional with pre-authorization, benefits determination, and provider network experience. Expert on commercial payer approval criteria and cultivating peer-to-peer relationships through the approval process to speed and smooth things along. Insightful researcher, skilled negotiator, and customer-centric administrator.

Overview

16
16
years of professional experience

Work History

AMS Care Coordinator

Concentra Medical Centers

Insurance Verification Specialist

Nevada

Insurance Administrator III

Orthofix Inc
10.2015 - Current
  • Lead efforts to verify patient insurance coverage for musculoskeletal medical devices
  • Subject matter expert (SME) on carrier guidelines, pre-approval processes, and benefit payments; research new payers’ policies and procedures
  • Assign daily departmental target goals
  • Train new staff on processes and update team on new policy changes
  • Determine revenue based on allowable charge, benefits paid, unit price, payer guidelines, and any co-payments
  • Critique claim documentation for completeness of medical information, including prescriptions, medical necessity, and chart notes
  • Collaborate with company’s other regional offices to ensure adequate backup to maintain order processing turnaround time and prevent backlogs
  • Identify new contracting opportunities and refer them to Corporate Accounts
  • Devised regional payer guide that shows requirements for each carrier to ease processing time and maintain accuracy; tool now mandated for use nationwide
  • Successfully manage cross-disciplinary relationships that include corporate accounts, territory managers, regional and case managers, adjusters, medical directors, business partners, and company leadership

Authorization Specialist

Intrepid USA Healthcare Services
10.2009 - 10.2015
  • Verified benefit coverage and obtained authorizations for clients of 15 of Intrepid’s home health and hospice agencies
  • Confirmed participation in insured’s provider network and advised agency on network status and reimbursement level
  • Filed appeals of denied claims and provided additional documentation if requested
  • Cultivated good working relationships with peers at agencies and public and private payers
  • Super User who trained staff on system updates
  • Mastered authorization processes of multiple commercial payers
  • Reengineered benefit authorization process to cut time from up to a week to one day, saving expense of services delivered before approval processing date.

Treatment Decision Support (TDS) Coordinator

United Healthcare
04.2007 - 10.2009
  • Orchestrated smooth process flow of several work queues for team of TDS Nurses to review
  • Telephonically enrolled new members, verified eligibility, arranged appointments, and assigned cases to TDS Nurses
  • Oversaw all documentation and researched and followed-up on patients who qualified for TDS diagnoses
  • Led departmental training initiatives
  • Collaborated with TDS Nurses on identifying the best providers regardless of network or cost.

Education

Associate of Science - General Studies

Mississippi Delta Community College
Moorhead

MS Certified Revenue Cycle Representative (CRCR) -

CRCR
Lewisville
02.2020

Skills

  • Areas of Expertise include:
  • Team Leadership
  • Home Healthcare
  • Pre-authorization
  • Managed Healthcare
  • Analytic Skills
  • Claims Data
  • Provider Relations

Timeline

Insurance Administrator III

Orthofix Inc
10.2015 - Current

Authorization Specialist

Intrepid USA Healthcare Services
10.2009 - 10.2015

Treatment Decision Support (TDS) Coordinator

United Healthcare
04.2007 - 10.2009

AMS Care Coordinator

Concentra Medical Centers

Insurance Verification Specialist

Nevada

Associate of Science - General Studies

Mississippi Delta Community College

MS Certified Revenue Cycle Representative (CRCR) -

CRCR

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