Amy Lee
Huntertown,IN
Summary
Dynamic Prior Authorization Specialist with extensive experience at Women’s Health Advantage, adept at streamlining authorization processes and enhancing operational efficiency. Skilled in medical terminology and effective communication, I excel in resolving complex cases and fostering provider relations, ensuring compliance and timely approvals in a fast-paced healthcare environment.
Overview
25
25
years of professional experience
Work History
Prior Authorization Specialist /Surgery Scheduling
Women’s Health Advantage
09.2011 - Current
- Process prior authorization requests to ensure compliance with insurance policies, by phone, fax and online.
- Developed standard operating procedures to enhance operational efficiency in the authorization process.
- Maintain thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Collaborate with physicians to obtain necessary clinical information for prior authorization submissions.
- Analyze complex cases, identifying potential issues and recommending solutions to expedite processing.
- Inform physicians of denials, detailing reasons for denial and possible appeal measures.
- Coordinate with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
Front Office /Medical Appointment Scheduler
Pain Management Associates
10.2004 - 09.2011
- Patient Check-In. Accuracy in entering patient demographic and insurance information.
- Check-Out. Scheduled follow up appointments, procedures, and diagnostic radiology testing for patients. Educated patients about tests and procedures.
- Obtained payments and did nightly deposits.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Provided exceptional customer service to patients, addressing inquiries and resolving issues related to scheduling or billing concerns.
Test Scheduler / Surgery Clerk
Orthopedics Northeast
09.2000 - 10.2004
- Scheduled Diagnostic Radiology testing and Epidural blocks for orthopedic patients
- Precision in checking patient's medications and allergies along with any risk factors they might have for the test or procedure.
- Prior Authorization of tests through patient's insurance company.
Education
Indiana Purdue Fort Wayne
Fort Wayne, INSkills
- Prior authorization process
- Medical terminology
- Insurance verification
- Effective communication skills
- Process improvement strategies
- Retro-authorizations
- Patient confidentiality compliance
- Provider relations
- Proficiency in ModMed, Microsoft Office, Provider Flow, Greenway
- Task prioritization
Timeline
Prior Authorization Specialist /Surgery Scheduling
Women’s Health Advantage
09.2011 - Current
Front Office /Medical Appointment Scheduler
Pain Management Associates
10.2004 - 09.2011
Test Scheduler / Surgery Clerk
Orthopedics Northeast
09.2000 - 10.2004
Indiana Purdue Fort Wayne
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