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, OR
Skills
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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