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Skills

  • Insulin medication assistance
  • Insurance policy interpretation and review
  • Home care
  • Data entry
  • Trauma recovery
  • Metrics tracking and KPI improvement
  • Advanced proficiency in category
  • Insurance dispute resolution
  • Denial and appeals management
  • Electronic Medical Records (EMR) proficiency HubSpot

Work Experiences

  • Audited charts and reviewed clinical documents to ensure accuracy.
  • Achieved a department-wide reduction in case processing times.
  • Advocated for patients' cases.
  • Collaborated on the development of an automated authorization submission tool, which decreased processing times by 66%.
  • Assessed the completeness and accuracy of prior authorization submissions, reducing the percentage of rejected claims by 35% over several months.
  • Achieved an efficiency increase of 81%.
  • Prepared blood, tissue, and other laboratory specimens for testing in the lab.
  • Recorded details about all therapies, including procedure and standard to keep patient charts up to date.
  • Aimed at improving prior authorization practices.
  • Was in charge of providing direct care to up to 18 patients on a 2-bed medical-surgical unit, delegating nursing assignments, and supervising a team of nurses, LPNs, technicians, and unit clerks.

Summaries

  • Prior Authorization Nurse is a multi-talented Prior Authorization Nurse who is consistently rewarded for planning and operational improvements.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the procedure business.
  • Achieved consistent authorization approval improvements.
  • With strong attention to detail, clinical expertise, and emergency response experience, she is adaptable and resilient.
  • Professionally trained with team leadership and client relations abilities.
  • Prior Authorization Nurse with 7 years of experience treating patients and coordinating care with other healthcare professionals.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Prior Authorization Nurse with 12 years of successful cross-functional collaboration and stakeholder engagement experience.
  • Dedicated, hardworking, and experienced procedure Registered Nurse with experience in patient care, medication monitoring, and treatment management.
  • Clear understanding of risk assessment and performance reporting as well as risk assessment training.

Accomplishments

  • Reduced the average denial response time from three years to one year, allowing for faster appeals processing and improved patient access to care.
  • Analyzed denial trends and optimized prior authorization processes, reducing payer denials by 49% over several months.
  • Developed a cross-functional communication approach with pharmacists, resulting in a 34% reduction in treatment delays due to pending authorization.
  • Improved department efficiency by leading the implementation of standard, which reduced manual entries and cut prior authorization errors by 70%.
  • Established an efficient tracking system to monitor prior authorization and appeals processes, reducing time-to-completion for cases by 18%.
  • Collaborated with team of 7 in the development of procedure.
  • Performed root-cause analysis on denied cases, resulting in the overhaul of our submission checklist and a subsequent reduction of denial rates by 53%.
  • Collaborated closely with the billing department to ensure correct coding for authorization requests, reducing denials for coding discrepancies by 54%.
  • Implemented an advanced automated tracking system for prescription authorizations, cutting down approval turnaround time by 83%.
  • Championed new workflows with payers to expedite review times, shortening the authorization process by 80% days on average.

Affiliations

  • International Association of Privacy Professionals (IAPP)
  • American Medical Billing Association (AMBA)
  • Health Care Compliance Association (HCCA)
  • American Health Information Management Association (AHIMA)
  • Utilization Review Accreditation Commission (URAC)
  • National Association of Social Workers
  • National Nurses United (NNU)
  • Healthcare Financial Management Association (HFMA)
  • Lean Six Sigma Healthcare Network
  • International Association of Administrative Professionals

Certifications

  • SHRM Certified Professional (SHRM-CP)
  • Certified Health Data Analyst (CHDA)
  • Google Certified Professional Cloud Architect
  • CompTIA Security+
  • Certified Prescriptive Authority Nurse (C-PAN)
  • Cisco Certified Internetwork Expert (CCIE)
  • ACMA Board Certified Case Manager (ACMA-BCM)
  • CompTIA Network+
  • Certified Revenue Cycle Specialist (CRCS)
  • Certified Professional Coder (CPC) by AAPC

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