Prior Authorization Specialist Resume Samples

A Prior Authorization Specialist takes charge of monitoring and overseeing all aspects of the prior authorization process. Roles and responsibilities commonly seen on the Prior Authorization Specialist Resume are – collecting necessary documentation, contacting the client to gather further information, completing required prior authorization for processing testing; completing and identifying accurately prior and retro authorization requests to the payors; updating patient and claim information, and identifying prior authorization trends that result to delayed claims processing. Other duties include verifying insurance eligibility, coordinating and supplying information to the review organization; and determining inpatient Medicare coverage.

The nature of the work demands the following skills and abilities – proficiency with medical billing software, knowledge of online insurance eligibility systems; excellent typing and computer skills; and familiarity with medical terminologies. A relevant degree is commonplace among job applicants.

Prior Authorization Specialist Resume example

Prior Authorization Specialist Resume

Summary : Seeking a career with a progressive organization where utilize skills, knowledge and experience in a challenging role that allows for advancement and growth.

Skills : Microsoft Office. Knowledge Of Medical Terminology,.

Description :

    1. Processed incoming Commercial and Medicaid Prior Authorization request via phone and fax.
    2. Advised Pharmacies and Providers of policy holder benefits.
    3. Processed Pharmacy claim rejections.
    4. Answered incoming Pharmacy helpdesk inquiries.
    5. Verified patient insurance coverage, determines eligibility and benefits.
    6. Provided excellent customer service to both internal and external customers.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Undergraduate In Biology


Sr. Prior Authorization Specialist Resume

Objective : Like to obtain a position with a company which offers fair compensation to its employees, reasonable benefits and has room for growth and advancement.

Skills : MS Office Suite, Windows Vista/ XP, Email, Internet.

Description :

    1. Confirmed their diagnosis and CPT codes for the requested procedures/ visits and then contact the insurance carriers or case workers to obtain necessary authorizations.
    2. Worked with the pain clinics, responsible for creating new accounts for upcoming cosmetic procedures.
    3. Processed approvals and denials.
    4. Screened and selected intelligence reports and documents to be entered into the INR information handling system.
    5. Analyzed data in response to requests for intelligence, research, documents, and other related requirements from Intelligence and Research analysts
    6. Able to obtain and maintain a Top Secret security clearance.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Certification In Phlebotomy


Jr. Prior Authorization Specialist Resume

Headline : To obtain a position that will allow to utilize skills and training to provide for professional growth and advancement.

Skills : Encouraging others in environment whether at work,.

Description :

    1. Answered incoming inquiries from providers and policy holders regarding pharmacy benefits.
    2. Performed overrides on medications as needed.
    3. Educated members, pharmacies and providers on administrative procedures and benefit information for covered procedures and benefits.
    4. Responded to all inquiries with professional attitude.
    5. Maintained standards of quality and adherence on a monthly basis.
    6. Utilized resources to provide quality responses.
    7. Facilitated resolution of drug coverage issues and pro-actively address, research and resolve issues while maintaining accurate and complete documentation of all inquiries for continuous improvement.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
AA Business Management

Prior Authorization Specialist I Resume

Objective : To obtain a rewarding position that will allow to utilize education as a professional administrative assistant and challenge the skills and knowledge acquired from past work experiences.

Skills : Document Production, Data Base Creation And Maintainance.

Description :

    1. Received, audited, and processed incoming service authorizations for Medicaid services.
    2. Responsible for auditing incoming applications and verifying all required information is submitted.
    3. Verified the provider and client information for eligibility as well as current services.
    4. Ensured requested services are authorized accurately, research procedure and diagnosis codes for criteria.
    5. Researched existing authorizations billing information to ensure services are not duplicated.
    6. Sent provider and client authorization information.
    7. Communicated, verified the contact information directly with the provider before resending due to HIPPA Laws.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Vocational In Legal Administrative Assistant

Prior Authorization Specialist II Resume

Summary : To obtain a Manager Position in the area of Customer Service that allows to use extensive experience in a business environment, to support company goals and initiatives.

Skills : EHR, Microsoft Office, CPT, ICD-10-PCS, ICD-10-CM.

Description :

    1. Obtained precertification or predetermination as required from third-party payers.
    2. Performed investigations into payment denials as well as initiated and followed up written appeals.
    3. Researched the medical policies of various payers to maximize reimbursement as well for the purpose of investigating denials.
    4. Ensured the proper clinical documentation was in place as needed to obtain preauthorization and queried providers for clarity.
    5. Interacted with patients to address questions regarding their authorization or billing questions.
    6. Provided information to clients, participants, pharmacists and doctors regarding participants pharmacy benefit, drug coverage and provide accurate procedures for medication exceptions.
    7. Reviewed requests from the Department and the U.S. Intelligence community for all-source intelligence across interrelated geographical and functional areas.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Associate In Health Information Technology

Prior Authorization Specialist III Resume

Objective : Actively seeking a customer service position where optimize problem-solving and organizational skills to contribute to increased customer satisfaction.

Skills : Microsoft Office,, Customer Service, Training & Development.

Description :

    1. Obtained timely authorizations from various insurance companies.
    2. Communicated with insurance carriers, both internal and external customers and patients via phone or written correspondence.
    3. Followed up on insurance determination.
    4. Reported to supervisor to assure accurate capture of services needing authorization.
    5. Verified insurance eligibility and benefits.
    6. Responsible for selecting accurate medical records for patient safety and obtaining and validating demographic and insurance information.
    7. Responsible for providing all required medical information to insurance companies as necessary to facilitate the authorization process.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Business Administration

Prior Authorization Specialist/Assistant Resume

Summary : Like to obtain a position with a company which offers fair compensation to its employees, reasonable benefits and has room for growth and advancement.

Skills : MS Office Suite, Windows Vista/ XP, Email, Internet.

Description :

    1. Processed the prior authorizations for the Duke Raleigh and WakeMed Cary Pain Centers.
    2. Responsible for accessing the hospitals' websites to obtain patient information for daily schedules at the clinics.
    3. Verified their demographics and insurance or workers compensation eligibility.
    4. Researched and confirmed their diagnosis/ICD-10 code(s) and CPT codes for the requested procedures/ visits.
    5. Responsible for obtaining medical records and submitting them, along with any necessary request forms, to the carriers for review.
    6. Worked with the pain clinics, also responsible for account origination of upcoming cosmetic and prepaid procedures.
    7. Contacted to make the payment on the procedure prior to their date of service.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Certification In Phlebotomy

Associate Prior Authorization Specialist Resume

Headline : Special Skills and Highlights: Administrative/Managerial experienced and trained. Customer Service oriented and skilled. Collaborates well with a variety of people and job functions. Efficient and effective in getting work accomplished in a timely manner. Strong listening skills with the ability to identify the needs of others.

Skills : Administrative/Managerial Experienced And Trained.

Description :

    1. Answered phone calls from Physicians, Hospital and patient using exemplary customer service skills.
    2. Scheduled new patient consultations, sleep studies and follow up appointment with the appropriate providers using a complex scheduling system.
    3. Verified patient's insurance benefits and eligibility.
    4. Reviewed structured clinical data matching it against specific medical terms and diagnosis or procedure codes and follow established procedures for authorizing request or referring request for further review.
    5. Maintained patient confidentiality as defined by state, federal and company regulations.
    6. Worked closely with MA's, check in staff along with Insurance companies to check benefits, eligibility for surgeries and other medical procedures.
    7. Worked closely with the VA in Salt Lake and the VAC program.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
N/A In Business Administration

Assistant Prior Authorization Specialist I Resume

Summary : To obtain any position where customer service and interpersonal skills meet the employers expectations.

Skills : Prior Authorization, Customer Service, Claims Processing.

Description :

    1. Processed inbound prior authorization requests via phone and fax.
    2. Handled inbound telephone and written inquiries from pharmacists and doctors regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria.
    3. Facilitated resolution of drug coverage issues and pro-actively address research and resolve issues while maintaining accurate and complete documentation of all inquires for continuous improvement.
    4. Worked collaboratively with other associates and supervisor to ensure that best practices are shared.
    5. Included authorizing prior approval requests for all injectable medications.
    6. Charged for doing the clinical review and entering auto-authorizations.
    7. Prepared and coordinated accurate computer generated inventories and is often consulted on the status of intelligence equipment and intelligence critical system supplies.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Medical Assistant

Prior Authorization Specialist Resume

Objective : Highly motivated, dedicated individual with strong problem solving, customer service, organizational, and multi-tasking skills. Results-oriented and flexible team player who works effectively to achieve personal/business objectives.

Skills : Analytical , Decision-making , Detail Oriented, Interpersonal ,.

Description :

    1. Contacted insurance carriers to verify patient's insurance eligibility benefits and requirements.
    2. Requested, tracked, and obtained pre-authorization from insurance carriers within time allotted for medical services.
    3. Requested, followed-up and secured prior-authorizations prior to services being preformed.
    4. Worked in collaboration with the medical sites to obtain any additional clinical documentation that can be forwarded to insurance carrier.
    5. Provided direct support to Referral Coordinators.
    6. Maintained a level of productivity suitable for the department.
    7. Managed the Medicare Part D and commercial plans PBM activity and prior authorizations.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Diploma In Medical Billing And Coding