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 :
- Processed incoming Commercial and Medicaid Prior Authorization request via phone and fax.
- Advised Pharmacies and Providers of policy holder benefits.
- Processed Pharmacy claim rejections.
- Answered incoming Pharmacy helpdesk inquiries.
- Verified patient insurance coverage, determines eligibility and benefits.
- Provided excellent customer service to both internal and external customers.
Experience
7-10 Years
Level
Management
Education
Undergraduate In Biology
Sr. Prior Authorization Specialist Resume
Objective : As An Prior Authorization Specialist, responsible for coordinating the medical review of referrals from physicians and other prescribers for complex or expensive medical devices, drugs, and treatments.
Skills : Customer Service, Clinical Resource, Patient Care.
Description :
- Confirmed their diagnosis and CPT codes for the requested procedures/ visits and then contact the insurance carriers or case workers to obtain necessary authorizations.
- Worked with the pain clinics, responsible for creating new accounts for upcoming cosmetic procedures.
- Processed approvals and denials.
- Screened and selected intelligence reports and documents to be entered into the INR information handling system.
- Analyzed data in response to requests for intelligence, research, documents, and other related requirements from Intelligence and Research analysts
- Able to obtain and maintain a Top Secret security clearance.
Experience
2-5 Years
Level
Executive
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 :
- Answered incoming inquiries from providers and policy holders regarding pharmacy benefits.
- Performed overrides on medications as needed.
- Educated members, pharmacies and providers on administrative procedures and benefit information for covered procedures and benefits.
- Responded to all inquiries with professional attitude.
- Maintained standards of quality and adherence on a monthly basis.
- Utilized resources to provide quality responses.
- 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.
Experience
5-7 Years
Level
Executive
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 :
- Received, audited, and processed incoming service authorizations for Medicaid services.
- Responsible for auditing incoming applications and verifying all required information is submitted.
- Verified the provider and client information for eligibility as well as current services.
- Ensured requested services are authorized accurately, research procedure and diagnosis codes for criteria.
- Researched existing authorizations billing information to ensure services are not duplicated.
- Sent provider and client authorization information.
- Communicated, verified the contact information directly with the provider before resending due to HIPPA Laws.
Experience
2-5 Years
Level
Executive
Education
GED
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 :
- Obtained precertification or predetermination as required from third-party payers.
- Performed investigations into payment denials as well as initiated and followed up written appeals.
- Researched the medical policies of various payers to maximize reimbursement as well for the purpose of investigating denials.
- Ensured the proper clinical documentation was in place as needed to obtain preauthorization and queried providers for clarity.
- Interacted with patients to address questions regarding their authorization or billing questions.
- Provided information to clients, participants, pharmacists and doctors regarding participants pharmacy benefit, drug coverage and provide accurate procedures for medication exceptions.
- Reviewed requests from the Department and the U.S. Intelligence community for all-source intelligence across interrelated geographical and functional areas.
Experience
10+ Years
Level
Senior
Education
Associate In Health Information
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 :
- Obtained timely authorizations from various insurance companies.
- Communicated with insurance carriers, both internal and external customers and patients via phone or written correspondence.
- Followed up on insurance determination.
- Reported to supervisor to assure accurate capture of services needing authorization.
- Verified insurance eligibility and benefits.
- Responsible for selecting accurate medical records for patient safety and obtaining and validating demographic and insurance information.
- Responsible for providing all required medical information to insurance companies as necessary to facilitate the authorization process.
Experience
2-5 Years
Level
Executive
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 :
- Processed the prior authorizations for the Duke Raleigh and WakeMed Cary Pain Centers.
- Responsible for accessing the hospitals' websites to obtain patient information for daily schedules at the clinics.
- Verified their demographics and insurance or workers compensation eligibility.
- Researched and confirmed their diagnosis/ICD-10 code(s) and CPT codes for the requested procedures/ visits.
- Responsible for obtaining medical records and submitting them, along with any necessary request forms, to the carriers for review.
- Worked with the pain clinics, also responsible for account origination of upcoming cosmetic and prepaid procedures.
- Contacted to make the payment on the procedure prior to their date of service.
Experience
10+ Years
Level
Senior
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 :
- Answered phone calls from Physicians, Hospital and patient using exemplary customer service skills.
- Scheduled new patient consultations, sleep studies and follow up appointment with the appropriate providers using a complex scheduling system.
- Verified patient's insurance benefits and eligibility.
- 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.
- Maintained patient confidentiality as defined by state, federal and company regulations.
- Worked closely with MA's, check in staff along with Insurance companies to check benefits, eligibility for surgeries and other medical procedures.
- Worked closely with the VA in Salt Lake and the VAC program.
Experience
5-7 Years
Level
Executive
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 :
- Processed inbound prior authorization requests via phone and fax.
- 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.
- 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.
- Worked collaboratively with other associates and supervisor to ensure that best practices are shared.
- Included authorizing prior approval requests for all injectable medications.
- Charged for doing the clinical review and entering auto-authorizations.
- Prepared and coordinated accurate computer generated inventories and is often consulted on the status of intelligence equipment and intelligence critical system supplies.
Experience
10+ Years
Level
Senior
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 :
- Contacted insurance carriers to verify patient's insurance eligibility benefits and requirements.
- Requested, tracked, and obtained pre-authorization from insurance carriers within time allotted for medical services.
- Requested, followed-up and secured prior-authorizations prior to services being preformed.
- Worked in collaboration with the medical sites to obtain any additional clinical documentation that can be forwarded to insurance carrier.
- Provided direct support to Referral Coordinators.
- Maintained a level of productivity suitable for the department.
- Managed the Medicare Part D and commercial plans PBM activity and prior authorizations.
Experience
2-5 Years
Level
Executive
Education
Diploma In Medical Billing
