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Skills

  • Team management
  • First Aid/CPR
  • Retro-Authorizations
  • Payment collection
  • Database management
  • Benefit Coverage
  • Standard equipment
  • Cross-functional team collaboration
  • Authorization workflow streamlining
  • Data entry

Work Experiences

  • Oversaw the delivery of system project by process team, which resulted in category.
  • Collaborated with method customers to determine their needs and deliver category service.
  • Requests for nonstandard services were escalated to category personnel in team leadership.
  • Compressed approval times from several months to category.
  • Contributed to operational improvements.
  • Clarified medical necessity documentation.
  • Collaborated with the billing department.
  • Worked with Prior Authorization Technicians to process patients who were not covered for scheduled procedures.
  • Achieved results in 2022.
  • Checked service providers' eligibility and compliance with authorization requirements.

Summaries

  • 2 years of project management experience as a cooperative correspondence clerk.
  • Within Pharmacy, senior Prior Authorization Technician and outstanding performer in quality assurance and vendor management.
  • Customer service skills are exceptional, as is typing accuracy.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Boosted overall efficiency.
  • Prior Authorization Technician with 2 years of successful strategic planning and vendor management experience.
  • Collaborative professional adept at cross-departmental work.
  • Adept at creating efficient workflows.
  • Maintains a sympathetic and compassionate relationship with customers.
  • Achieved a 44% approval rate.

Accomplishments

  • Worked closely with medical billing specialists to align on coding compliance, ensuring smooth processing of prior authorizations and minimizing delays.
  • Successfully handled over 7 oncology prior authorization cases, preventing revenue losses of 9 in 2023.
  • Developed insight reports for senior management based on trends in denied claims, contributing to a 44% improvement in approval rates.
  • Regularly monitored and updated payer documentation guidelines, ensuring all prior authorization submissions met compliance standards.
  • Contributed to the development of an error-reporting system that reduced authorization failures by 33%, directly improving payer relations.
  • Developed and standardized templates for frequently-manual documentation processes, cutting time spent on authorizations by 84% per request.
  • Analyzed claim denial patterns, enabling targeted appeals that led to the recovery of 8 within one year.
  • Played a key role in cross-functional team initiatives, improving patient turnaround times for high-dollar authorizations by 71%.
  • Served as subject-matter expert on specialty drug authorizations, providing critical guidance to clinical teams and reducing prescription approval wait times.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.

Affiliations

  • Certified Professional in Health Information Management (CPHIM)
  • Certification in Healthcare Regulatory Compliance
  • Society of Healthcare Insurance Professionals
  • American Marketing Association
  • Lions Club
  • National Healthcareer Association (NHA)
  • Certification in Medical Necessity Review Process
  • American Society of Safety Professionals
  • Society of Women Engineers
  • National Council for Prescription Drug Programs (NCPDP)

Certifications

  • Certified Medical Reimbursement Specialist (CMRS)
  • Advanced Prior Authorizations and Appeals Certification - Cedar Works
  • Certified Business Analysis Professional (CBAP)
  • Certified Health Insurance Specialist (CHIS)
  • Project Management Professional (PMP)
  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Revenue Cycle Specialist (CRCS)
  • SHRM Certified Professional (SHRM-CP)
  • Pharmacy Technician Certification Board (PTCB) - 2021
  • Microsoft Certified Systems Engineer (MCSE)

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