Experience

Masonicare

• United States
• Hospitals and Health Care
• 400 - 500 Employee

• Authorization Specialist

  • Jul 2022 - Present

  Responsible for ensuring authorizations for commercial payors are obtained, received and enteredin electronic medical record keeping system in a timely and accurate manner.● Coordinates with Insurance Verification to ensure ongoing authorization is obtained● Establishes and maintains a tracking system for authorizations and communicates information tothe branches requiring authorizations.● Documents all authorization requests in the EMR and follow up on requests at appropriateintervals as necessary● Communicates and works with branch clinicians on an ongoing basis in order to receiveauthorization for services. Ensures timely receipt of authorizations Show less



Hospital for Special Care

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Insurance Authorization Representative

  • Jan 2021 - Apr 2022

  Maintains, confirms and secures referrals, authorization, or pre-certifications required for patients to receive physician or medical services. Verifies the accuracy and completeness of patient account information. Maintains database of payer authorization requirements.Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third party payer requirements/on-line eligibility systems.Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for patients. Follows up with physician offices, financial counselors, patients and third-party payers to complete the pre-certification process.Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance.Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status. May notify ordering providers if authorization/certification is denied.May coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures.Maintains files for referral and insurance information, and enters referrals into the system.Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans. Show less

• Outpatient Admissions Representative

  • Dec 2018 - Dec 2020

  Responsible for the smooth operations of all front desk/reception area functions as well as other administrative/clerical duties. Pre-admission and admission of all hospital outpatients, ensuring the adequate financial backing. Responsible for accurate and timely preparation and submission of all assigned patient accounts, including charge entry. Performs ongoing analysis of accounts to determine continuation of eligibility of benefits and implements appropriate appeals, coordination of benefits, adjustments, and re-authorizations. Show less

• Data Quality Analyst

  • Apr 2015 - Dec 2018

  Participated in risk identification, trending, and reporting of actual and potential quality and patient safety opportunities assisting in coordinating data collection, data modeling and review.Facilitated, coordinated and completed data collection in regard to key organizational outcomes such as durability, effectiveness and patient satisfaction.Participated in High Reliability Organization.



Yale New Haven Hospital

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Outpatient Registration

  • Aug 2011 - Apr 2015