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Skills

  • Process improvement
  • HIPAA compliance
  • Organization
  • Workflow Optimization
  • Appeal Submission
  • Team Leadership
  • Regulatory compliance
  • Customer service
  • Authorizations
  • Advanced Claim Processing Techniques

Work Experiences

  • Checked service providers' eligibility and compliance with authorization requirements.
  • Achieved a 21% reduction in authorization request errors.
  • Assessed authorization accuracy.
  • Coordinated and participated in peer-to-peer reviews with insurance medical directors, securing approved authorizations across 17 high-cost procedures.
  • Achieved a 34% improvement in response times.
  • Achieved a 50% increase in patient satisfaction scores.
  • Contributed to the reduction in rejected claims by auditing prior authorization submissions for policy compliance, lowering rejections by 67%.
  • Kept track of office supplies by checking inventory and ordering new supplies as needed.
  • Customer service, patient scheduling, and billing were among the duties I coordinated in the front office.
  • Assessed complex cases and submitted appeals on behalf of patients, resulting in a 23% overall reversal of denied claims.

Summaries

  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Prior Authorization Coordinator is a multi-talented Prior Authorization Coordinator who is consistently rewarded for planning and operational improvements.
  • Opportunity to learn German was pursued in order to improve support for standard populations.
  • Proven experience in system and process environments, as well as knowledge of provider requirements.
  • With over 18 years of experience in the category industry, I am committed to organization and collaboration.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Maintain high-volume medical offices by coordinating files, appointments, and other patient needs efficiently.
  • Prior Authorization Coordinator with 5 years of successful team leadership and client relations experience.
  • Knows how to manage charts, forms, and payments.
  • Dedicated to streamlining organizational procedures in order to improve office environments.

Accomplishments

  • Trained a team of 7 authorization specialists to enhance procedural knowledge, reducing the average error rate by 84% over two years.
  • Worked closely with providers and insurance representatives to resolve disputes, achieving a 76% approval rate on denials.
  • Streamlined internal workflows by integrating QuickBooks into authorization tracking, improving processing time by 82%.
  • Built and maintained relationships with payers, resulting in a 34% improvement in on-time reimbursements.
  • Reduced authorization turnaround time from 16 days to 13 days by enhancing relations with healthcare payers.
  • Resolved product issue through consumer testing.
  • Provided training and mentorship to junior staff, driving a 73% improvement in overall departmental efficiency.
  • Partnered with compliance and legal teams to implement new protocols, ensuring 38% adherence to payer guidelines.
  • Documented and resolved framework which led to program.
  • Led the implementation of new electronic submission software, decreasing average authorization approval turnaround by 14 days.

Affiliations

  • Case Management Society of America (CMSA)
  • American Society for Healthcare Engineering (ASHE)
  • Institute for Healthcare Improvement (IHI)
  • Society of Women Engineers
  • Accreditation Association for Ambulatory Health Care (AAAHC)
  • Certification in Healthcare Compliance (CHC) – Health Care Compliance Association (HCCA)
  • International Council of Nurses
  • American Association of Managed Care Nurses (AAMCN)
  • National Association for Healthcare Quality (NAHQ)
  • Toastmasters

Certifications

  • Professional Prior Authorization Coordinator (PPAC) by method
  • Cisco Certified Network Associate (CCNA)
  • Insurance Billing & Coding Specialist Certification by system
  • Certified Business Analysis Professional (CBAP)
  • Certified Clinical Documentation Specialist (CCDS) by ACDIS
  • SHRM Senior Certified Professional (SHRM-SCP)
  • ServSafe
  • Certified Medical Billing Specialist (CMBS) by MAB
  • Certified Public Accountant
  • Certified Electronic Health Records Specialist (CEHRS) by system

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