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Skills

  • Escalation management
  • Process improvement
  • Pharmacology
  • Claim Reversals and Appeals
  • Appeal Submission
  • Operational improvement
  • Medical coding
  • Retro-Authorizations
  • EPIC
  • Authorizations

Work Experiences

  • Authored training materials and job aids to ensure consistent application of prior authorization policies among new team members.
  • Audited prior authorization submissions for policy compliance.
  • Prioritized unscheduled and emergency authorizations, routing them to the appropriate personnel for immediate action.
  • Kept track of referral submissions during the facilitation of prior authorization issuance.
  • Coached team members to enhance productivity.
  • Assessed authorization accuracy.
  • Analyzed weekly performance reports on authorization workflows.
  • Contributed to the reduction in rejected claims by auditing prior authorization submissions for policy compliance, lowering rejections by 67%.
  • Aligned patient treatment plans with insurance guidelines.
  • Achieved over 72% compliance each quarter.

Summaries

  • Knows how to manage charts, forms, and payments.
  • Opportunity to learn German was pursued in order to improve support for standard populations.
  • Achieved a 82% reduction in authorization issues.
  • Achieved 20% success in reversing denied claims.
  • Dedicated to following the medical funding guidelines and policies that have been established.
  • Achieved 57% faster authorization processing.
  • Prior Authorization Coordinator with 12 years of experience in framework industry is meticulous.
  • Clear understanding of risk assessment and data analysis as well as workflow optimization training.
  • Prior Authorization Coordinator is a meticulous Prior Authorization Coordinator who is dedicated to never allowing critical requests or documents to go unprocessed.
  • Experienced in dealing with insurance paperwork, updating charts, and managing business correspondence.

Accomplishments

  • Led a pilot initiative with external payers, improving pre-authorization approval rates by 64% before full system rollout.
  • Documented and resolved framework which led to program.
  • Built and maintained relationships with payers, resulting in a 34% improvement in on-time reimbursements.
  • Advocated and secured insurance approval for specialized treatments, delivering timely access to care for 15 patients.
  • Served as a point of contact for escalated authorization concerns, successfully resolving 6 of complex cases with an 61% resolution rate.
  • Reduced manual data entry errors by implementing automation tools, leading to a 42% decrease in submission inaccuracies.
  • Implemented a pre-submission verification checklist, reducing the number of denied authorizations by 84%.
  • Resolved product issue through consumer testing.
  • Maintained compliance with payer regulations across all submissions while enhancing overall workflow completion efficiency by 62%.
  • Implemented real-time tracking of pending authorizations to effectively communicate delay risks to clinical teams, resulting in a 36% increase in workflow transparency.

Affiliations

  • Association for Community Affiliated Plans (ACAP)
  • Project Management Institute
  • Association for Computing Machinery
  • Jaycees
  • American College of Healthcare Executives (ACHE)
  • National Association for Healthcare Quality (NAHQ)
  • Freemason
  • Association for Radiologic & Imaging Nursing (ARIN)
  • International Federation of Health Plans (IFHP)
  • National Healthcareer Association (NHA)

Certifications

  • National Certified Medical Office Assistant (NCMOA) by NAHP
  • Certified Inpatient Coder (CIC) by AAPC
  • Certified Specialist in Managed Care (CSMC) by AAHAM
  • Certified Healthcare Access Associate (CHAA) by NAHAM
  • Certified Healthcare Financial Professional (CHFP) by program
  • Certified Medical Reimbursement Specialist (CMRS) by AMBA
  • Project Management Professional (PMP)
  • Epic Certified Professional in Prior Authorization Workflow Management
  • Professional Prior Authorization Coordinator (PPAC) by method
  • ServSafe

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