Unique Grant
Chicago,IL
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Organized and dependable professional with a positive attitude.
Overview
8
8
years of professional experience
Work History
Prior Authorization Specialist
Aetna, A CVS Health
11.2018 - 04.2023
- Processed over 50 prior authorization requests per day for variety of behavioral health services via phone, fax and email
- Input all members data regarding claims and prior authorizations into system accurately while maintaining confidentiality.
- Analyzed clinical documents to determine approval of requests for authorization.
- Provided prior authorization support for clinician, healthcare providers, and members in accordance with payer guidelines
- Communicated authorization approvals, denials and appeals information to clinician and members.
- Resolved providers or member concerns with prior authorization process. eliminating unnecessary phone transfers.
- Made outbound calls to clinician to obtain additional clinical information or and missing clinical information.
- Extended authorizations when treatment has been delayed for members.
Patient Scheduling Coordinator
The Chicago Lighthouse
05.2015 - 08.2016
- Managed over 50 to 100 calls per day from busy scheduling queue for multiple clinics.
- Frequently double-checked patient histories and current information while scheduling follow-ups and other appointments.
- Maintained accurate patient records for proper tracking of patient history and treatment.
- Coordinated with other departments to facilitate seamless operation and excellent patient care.
- Maintained confidentiality of patient information to comply with HIPAA regulations and protect patient privacy.
- Managed multiple schedules and prioritized tasks to meet demands of fast-paced work environment.
Education
High School Diploma -
Simeon Career Academy
Chicago, IL06.2003
Skills
- Problem Resolution skills
- Effective Communication skills
- Time Management skills
- Detailed oriented
- Customer service skills
- Data Entry skills
Timeline
Prior Authorization Specialist
Aetna, A CVS Health
11.2018 - 04.2023
Patient Scheduling Coordinator
The Chicago Lighthouse
05.2015 - 08.2016
High School Diploma -
Simeon Career Academy
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