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Click here or scroll down to respond to this candidateCandidate's Name
Purcellville, VA Street Address Cell: PHONE NUMBER AVAILABLE EMAIL AVAILABLEProfessional SummaryExperienced Prior Authorization Specialist and administrator bringing enthusiasm, dedication and an exceptional work ethic. Trained in customer service with high volume inbound calls, with experience with EMR programs such as Epic, EClinicalWorks, eMDs, and AdvancedMDs alongside proficiency in Microsoft Office. High energy and outgoing with a dedication to positive guest relations.Former small business owner experience, such as: management, financials, training employees, and other paperworkSkillsCustomer serviceDriving continuous improvementManaging multiple projectsCPT/ICD 10/9 CodingUtilization ManagementHigh volume inbound calls (45/hr)Time/Business managementBusiness developmentInsurance Prior AuthorizationsClaims and AppealsWork HistoryPrior Authorization Specialist, 08/23 to 03/24Countryside Orthopaedics - Leesburg, VA(TEMPORARY)Reviewing Documentation: Assessing medical records, treatment plans, and physician orders to determine if prior authorization is necessary.Insurance Verification: Verifying patients' insurance coverage details, including eligibility, benefits, and prior authorization requirements using Availity, OneSource, Cortex, and payer portals.Completing Prior Authorizations: Filling out necessary paperwork accurately and completely, ensuring all required information is provided and submitting whether online portals, fax, or phone.Communication with Providers: Collaborating with healthcare providers to gather required documentation and information needed for prior authorization requests. Working closely with other members of the healthcare team, including physicians, nurses, billing specialists, and admin staff to facilitate the prior authorization process smoothly.Follow-Up: Tracking the progress of prior authorization requests and following up with insurance companies as needed to expedite the process.Documentation and Record-Keeping: Maintaining detailed records of prior authorization requests, approvals, denials, and communications with insurance companies.Reviewing Authorization Denials: Evaluate requests for medical services or procedures that were denied to see if they meet specific criteria and guidelines set by insurance providers for appeals.Appeals Process: Assisting with the appeals process in the event of a prior authorization denial, including gathering additional information or documentation to support the appeal.Patient Education: Communicating with patients about the prior authorization process, including any requirements, potential delays, or denials, and providing support and assistance as needed.Compliance: Ensuring compliance with healthcare regulations, including HIPAA guidelines, regarding patient privacy and confidentiality.Continuous Learning: Staying updated on changes in insurance policies, regulations, and procedures related to prior authorizations. Familiarizing oneself with insurance company policies, guidelines, and procedures regarding prior authorizations.Problem-Solving: Resolving issues or discrepancies related to prior authorization requests promptly and efficiently.Quality Improvement: Identifying opportunities for process improvement in the prior authorization process to enhance efficiency and patient satisfaction.Front Desk Receptionist, 03/23 to 08/23ENT and Allergy Specialists of Virginia - Ashburn, VA(TEMPORARY)Plan, coordinate and carry out patient care operations.Address patient requests and needs in a professional manner.Respond to patient concerns in a timely fashion.Schedule patient appointments and make reminder calls.Handle medical records in a timely fashionCollect and maintain patient health, demographic, insurance, and financial information.Suggest process improvements to enhance patient services.Adheres to the Tenet HIPAA Compliance Plan and the Privacy Standards Confidentiality AgreementVerifies insurance eligibility using Availity, OneSource, Cortex, and payer portals.Front Desk Receptionist, 03/22 to 03/23NVARO: Northern Virginia Center for Arthritis, Rheumatology, and Osteoporosis - Falls Church, VAPlan, coordinate and carry out patient care operations.Address patient requests and needs in a professional manner. Respond to patient concerns in a timely fashion.Schedule patient appointments and make reminder calls.Handle medical records in a timely fashionCollect and maintain patient health, demographic, insurance, and financial information.Suggest process improvements to enhance patient services.Adheres to the Tenet HIPAA Compliance Plan and the Privacy Standards Confidentiality AgreementVerifies insurance eligibility using Availity, OneSource, Cortex, and payer portals.Prior Authorization Coordinator, 08/2019 to 03/22The Arthritis and Rheumatology Clinical Center of Northern Virginia - Vienna, VAAddress patient requests and needs in a professional manner. Respond to patient concerns in a timely fashion.Schedule patient appointments and make reminder calls.Address front desk attendanceHandle medical records in a timely fashionMaintain PTO and timesheets on a bi-weekly basisComplete Prior Authorizations for IV infusions/injections for over 350 patients per month, denials, scheduling P2Ps, wrote appeal lettersVerified patient insurances and performed standard eligibility using Availity.Collect and maintain patient health, demographic, insurance and financial information.Adheres to the Tenet HIPAA Compliance Plan and the Privacy Standards Confidentiality AgreementPatient Care Coordinator, 05/2018 to 8/2019American Sleep Medicine - Vienna, VA(Permanently Closed)Plan, coordinate and carry out patient care operations.Address patient requests and needs in a professional manner.Schedule patient appointments and make reminder calls.Greet patients and direct them to examination rooms.Maintain patient medical records up-to-date.Collect and maintain patient health, demographic, insurance and financial information.Suggest process improvements to enhance patient services.DME programming Adjust DME pressures per doctors ordersCo Owner Small Business, 02/2015 to 05/2018The Attic Alchemist Reston, VA(Permanently Closed)Facilitated a fast-paced and dynamic entrepreneurial environment.Negotiated lucrative partnerships with Amazon.Maintained or improved margins over previous years.Ensured exceptional client service and quality product offerings, including handling telephone inquiries.Planned, coordinated and controlled daily operations of the organization.Reviewed sales price and operating costs.Maintained files and administrative records.Printed and confirming shipping labels.Supplied tracking information to customers. |
