Highly organized and detail-oriented administrative professional with over 10 years of experience in healthcare office management. Proven expertise in insurance policies, payer authorizations, and industry regulations with a strong focus on efficiency and patient satisfaction. Demonstrates excellent organizational, time-management skills, and proficiency in healthcare information systems and prior authorization software. Authorized to work in the US for any employer.
Penn Highlands Lung Center Lung Innovations Network
08.2022 - Current
Implemented process improvements that resulted in a 20% reduction in processing time for prior authorization requests, increasing overall efficiency and patient satisfaction
Cultivated strong relationships with insurance company representatives, leading to an 8% increase in timely authorization approvals thereby improving patient care and reducing wait times
Participated in relevant workshops, conferences, or training programs to enhance skills and stay informed about best practice
Effectively managed a high volume of prior authorization requests, meeting or exceeding established productivity targets contributing to the department's operational goals.
Prior Authorization Specialist
Clearfield Jefferson Primary Care Associates
08.2011 - 06.2022
Posted and adjusted payments for commercial, Medicare and Medicaid ensuring accurate and timely financial reconciliation
Handled authorization denials and appeals confidently and adeptly, achieving a 15% success rate in overturning initial denials, which improved patient access to necessary treatments
Examined patient's insurance coverage, deductibles, possible insurance carrier payments to provide accurate financial information, reducing billing errors by 10%
Identified and resolved patient billing and payment issues promptly, enhancing patient satisfaction and reducing accounts receivable by 12%
Responded to correspondence from insurance companies efficiently, maintaining a high standard of communication and ensuring swift resolution of queries.
Education
Academic -
Ridgway High School
Ridgway, PA
06.1997
Skills
Medical Office Experience
Insurance Verification
CPT Coding
ICD-10
Medical Terminology
Medical Billing
Computer skills
Medical terminology
CPT coding
ICD-9
EMR systems
Medical records
Organizational skills
Microsoft Excel
Microsoft Office
Ophthalmology
Healthcare Management
Certification
Pennsylvania State Police Clearance, 05/01/2024, Present
Penn Highlands Lung Center Lung Innovations Network
08.2022 - Current
Prior Authorization Specialist
Clearfield Jefferson Primary Care Associates
08.2011 - 06.2022
Academic -
Ridgway High School
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