Medical Insurance
Resume:
Atlanta, GA
Atlanta, GA
New York, NY
WENDY GRISSETT
Summary
Skilled and resourceful Pre-authorization analyst professional with over 7 years of experience in diverse environments with an outstanding record of improving performance and increasing productivity. Experience
Authorization Analyst
KForce, Inc
Verified applicable eligibility sharing requests for procedures to include, surgical intervention, diagnostic testing and both inpatient/outpatient operations.
Notified Provider/member in writing of the determination whether the procedure is approved or denied. Understanding of medical insurance terminology and concepts. Familiar with payer practices and procedures and medical coding. Review of medical narratives to identify the nature of a condition, whether it be pre-existing, chronic or acute.
Collaborate with management on condition in question. Identified cases that required intervention of a medical review officer. Pre-Authorization requests reviewed in a timely manner. Analytical and problem solving.
Precertification Scheduler
Northside Hospital Atlanta
Utilized proper CPT and ICD-10 codes for accurate precertification. Obtained patient information necessary for proper scheduling of examination if necessary. Made sure orders match scheduled procedures and consults with physicians offices to resolve discrepancies.
Retrieved missing orders from physicians offices.
Communicated and followed up with physicians offices, hospital departments and insurance companies to determine whether precert had been initiated and/or status cases where the authorization process ha been started.
Efficiently utilized computer scheduling system to precertify radiology procedures at Hospital and imaging centers.
Accurately noted accounts with precertifcation process to completion. Maintained HIPAA Compliance.
Pre-Authorization Specialist
Mount Sinai Beth Israel Comprehensive Cancer Center Pre-certified outpatient oncology patients having diagnostic and nuclear testing. Served as patient advocate and liason to assist patients with understanding the cost of care and guiding patient's through continuation of care.
Provided service in areas of financial needs to patient,family members and health care team. Worked with health insurance providers to determine coverage, benefit limits and financial responsibility and conveyed this information to the clinical team, patient and family. Submitted appropriate clinical information to insurance companies (all payers) and completing appeals process, using written, oral and online skill, as needed. Skills
EPIC, OneCall, Image freeway, Insurance websites (i.e. Evicore, Humana, Tricare, UHC) Centricity, eClinicals, Powerpath, Eagle(AS400), Excel, FACS, ONECONTENT, STAR, Admin123,Five9, RightFax 3750 Winners Circle #305, Palm Harbor, FL 34684 H: 347-***-**** ***********@*****.***
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