Experience

Mainbridge Health Partners

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Prior Authorization Manager

  • Apr 2021 - Present

• Prior Authorization Specialist

  • Apr 2021 - Present

• Prior Authorization Specialist

  • Apr 2021 - Present

  Complete benefit investigation for both medical and pharmacyProperly and precisely submit and obtain Prior Authorizations for requested therapyRead payer policy to find out requirements, read patients medical records to pull the requirements out, and load related documents to the platform to complete the PA portalMake rational, educated assumptions of risk for the practice based on medical documentation and plan coverageObtain approval/denial letters, review the denial reason and make a valid structured argument for the patient, advise the office of the result, and provide appeal services Show less



Pinnacle Home Care

• United States
• Hospitals and Health Care
• 200 - 300 Employee

• Authorization Coordinator

  • Apr 2019 - Present



Health Insurance Innovations Inc (HIIQ)

• Tampa/St. Petersburg, Florida Area

• Compliance Reporting Specialist

  • Aug 2017 - Mar 2018



UnitedHealth Group

• Hospitals and Health Care
• 700 & Above Employee

• Sr. Billing Analyst

  • Feb 2015 - Jun 2017

  Educate customers on premium payment options, and billing information. Generate and/or distribute reports and documentation (e.g. billing statements) to external customers to inform them of premium balances. Call or correspond with customers to verify data, inform them of billing problem/issue finding and resolution of outstanding balance and required payments as appropriate. Manage the preparation of invoices and complete reconciliation of account balance. Educate customers on premium payment options, and billing information. Generate and/or distribute reports and documentation (e.g. billing statements) to external customers to inform them of premium balances. Call or correspond with customers to verify data, inform them of billing problem/issue finding and resolution of outstanding balance and required payments as appropriate. Manage the preparation of invoices and complete reconciliation of account balance.



Sedgwick

• Insurance
• 700 & Above Employee

• Accounts Receivable Analyst

  • Dec 2008 - Mar 2009

  Manage monthly AR portfolio and assist with the preparation of monthly Financial reporting Oversee a comprehensive review of outstanding receivables and initiate follow through with collection accounts. Research and resolve account deductions including pricing errors, allowances, over/under payments, and issue refunds as necessary. Maintain timely and accurate records, customer communications, and account reconciliations. Manage monthly AR portfolio and assist with the preparation of monthly Financial reporting Oversee a comprehensive review of outstanding receivables and initiate follow through with collection accounts. Research and resolve account deductions including pricing errors, allowances, over/under payments, and issue refunds as necessary. Maintain timely and accurate records, customer communications, and account reconciliations.