Yazmin Allen
Lewisburg,TN
Summary
An efficient Senior Prior Authorization Specialist possessing extensive knowledge of medical insurance policies, coding, and procedures. Demonstrates a strong capability to facilitate communication among patients, healthcare providers, and insurance companies to ensure smooth transaction processes. Key strengths include exceptional problem-solving skills, meticulous attention to documentation, and an acute ability to identify inconsistencies. Previous roles have yielded measurable impacts, such as the streamlining of authorization processes, enhancement of patient satisfaction rates, and a reduction in claim denials.
Overview
9
9
years of professional experience
Work History
Senior Prior Authorization Specialist
Royal Health Solutions
Remote
07.2022 - Current
- Entered data into electronic medical record system accurately and efficiently.
- Maintained current knowledge of applicable regulations, laws, and standards.
- Participated in meetings with staff members from other departments such as billing and coding teams to provide clarification on policies related to authorizations.
- Researched clinical criteria and determined eligibility for requested services based on plan provisions.
- Assisted healthcare providers with appeals for denied authorizations, including gathering additional information and documentation.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Interpreted benefit language in order to determine covered services under each plan type.
- Trained new staff on prior authorization procedures and company policies.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients.
- Maintained files for referral and insurance information, entering referrals into system.
Centurion Membership Manager
American Express
Remote
12.2021 - 07.2022
- Serviced members with travel, card-servicing, and concierge requests from beginning to end, while displaying strong ownership and accountability while ensuring seamless delivery.
- Resolved customer inquiries and complaints requiring management-level escalation.
- Provided leadership, insight and mentored to newly hired employees to supply knowledge of various company programs.
- Proposed or approved modifications to project plans.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Generated reports related to sales activities, customer issues, account balances.
- Processed loan applications and reviewed credit reports for accuracy.
- Advised customers on how best to manage their finances in order to maximize returns.
- Prepared documents such as loan agreements, promissory notes, mortgages according to legal guidelines.
- Trained and coached less experienced team members in procedures, compliance standards and performance strategies.
MDS Team Lead
NaviHealth
Brentwood, TN
01.2019 - 12.2021
- Provided training and education to nursing staff on current MDS regulations.
- Implemented clinical system requirements, data release formats, delivery schedules and testing protocols to confer with end-users.
- Ensured that changes made to an existing plan of care corresponded with appropriate changes made on the corresponding MDS form.
- Increased productivity and efficiency by regularly reevaluating processes and technologies.
- Audited monthly MDS submissions for accuracy, timeliness, completeness and compliance with applicable regulations.
- Managed comprehensive, interdisciplinary assessments for patient admissions and annual reviews.
- Researched new developments in Medicare and Medicaid reimbursement policies related to long-term care facilities.
- Facilitated team meetings with members from other departments such as Social Services, Dietary, Activities, Rehabilitation services, to discuss resident issues and concerns related to the MDS process.
- Trained and supervised health care workers conducting resident assessments.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
Senior Account Manager
International Comfort Products
Lewisburg, TN
08.2016 - 01.2019
- Conferred with customers by telephone or in-person to provide information about products or services, receive and enter orders, cancel accounts, and obtain details of complaints
- Reviewed claim adjustments with dealers, examine parts order issues and approve or disapprove dealers’ claims
- Monitored and evaluate agent performance, providing learning or coaching opportunities, and taking corrective action, if necessary
- Prepared reports and analyzed data to assist management as they determine call center goals
- Negotiated contracts and closed agreements to maximize profits.
- Acted as main point of contact in matters relating to client concerns and needs.
- Mentored and internally promoted successful company sales and account management staff into leadership positions to drive company growth.
- Prepared budgets and approved budget expenditures.
Education
High School Diploma -
Marshall County High School
Lewisburg, TNSkills
- Good Multitasking Skills
- Self-motivated
- Commercial Insurance
- Appeals management
- Regulatory compliance
- Data analysis
- Medical terminology proficiency
- Healthcare regulations
- Medical coding
- Invoicing and billing
- Attention to detail
- Interdepartmental coordination
- Critical thinking
- Patient confidentiality compliance
- Insurance verification expertise
- Benefit interpretation
Timeline
Senior Prior Authorization Specialist
Royal Health Solutions
07.2022 - Current
Centurion Membership Manager
American Express
12.2021 - 07.2022
MDS Team Lead
NaviHealth
01.2019 - 12.2021
Senior Account Manager
International Comfort Products
08.2016 - 01.2019
High School Diploma -
Marshall County High School
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