Trisha Daberkow
Phoenix,AZ
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
4
4
years of professional experience
Work History
Prior Authorization Representative
Banner Healthcare
TUCSON, AZ
09.2022 - Current
- Communicates authorization decisions, including approvals and denials, to healthcare providers and patients.
- Educates customers about the prior authorization process, including applicable deadlines.
- Follows all Medicare, Medicaid, HIPAA, and private insurance regulations and requirements.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Helps to train new staff on prior authorization procedures when asked to do so.
- Provides customer service to patients and healthcare providers, answering questions related to prior authorization status.
- Coordinated with healthcare providers to gather necessary patient information for prior authorization requests when needed.
- Reviews and processes prior authorization requests for medical procedures and medications according to established guidelines.
- Applies knowledge of Medicare, Medicaid, and third-party payer requirements, utilizing online eligibility systems to verify patient coverage.
- Works effectively in team environments to make the workplace more productive.
- Assists with member requests and answered questions via the telephone to improve member satisfaction.
Medical Billing Specialist
Sierra Vista Medical Group
Sierra Vista, AZ
09.2021 - 09.2022
- Processed credit card payments from patients in accordance with office policy.
- Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
- Reconciled codes against services rendered.
- Assessed billing statements for correct diagnostic codes and identified problems with coding.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Reviewed claims for coding accuracy.
- Ensured HIPAA compliance by maintaining confidentiality of all patient information.
- Submitted claims to insurance companies.
- Answered customer questions to maintain high satisfaction levels.
- Performed insurance verification.
- Verified the accuracy of claim data prior to submission to insurance carriers.
Referrals Specialist
Sierra Vista Medical Group
Sierra Vista, AZ
09.2020 - 09.2021
- Scheduled and confirmed patient appointments and consultations.
- Verified insurance eligibility for referred services using online databases and contacted insurers directly when needed.
- Educated patients on the referral process, including expected timelines and preparation for specialist visits.
- Answered telephones and directed calls to appropriate medical or administrative staff.
- Facilitated communication between primary care physicians, specialists, and patients to ensure a smooth referral process.
- Reviewed all documentation associated with each referral request to ensure compliance with relevant regulations when needing to do so.
- Managed front office customer service and appointment management to help streamline workflow.
- Performed additional office duties, handling patient service inquiries and receiving payments.
- Answered questions and resolved concerns raised by both patients and specialists.
Education
Some College (No Degree) - Medical Secretary
Linn-Benton Community College
Albany, ORSkills
- Authorizations
- Medical terminology
- Patient scheduling
- Data entry proficiency
- Co-payment collection
- Insurance verification
Timeline
Prior Authorization Representative
Banner Healthcare
09.2022 - Current
Medical Billing Specialist
Sierra Vista Medical Group
09.2021 - 09.2022
Referrals Specialist
Sierra Vista Medical Group
09.2020 - 09.2021
Some College (No Degree) - Medical Secretary
Linn-Benton Community College
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