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Health Care Prior Authorization

Location:
Sandusky, OH
Salary:
20.00
Posted:
January 28, 2024

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Resume:

Sue Karis

Sandusky, OH *****

ad2564@r.postjobfree.com

+1-419-***-****

Seeking a responsible position as an where my experience and knowledge are fully employed, as well as being a valuable team player. Good listening skills, multitaske, audit performance with the DEA, Medical Board and Pharmacy

Board, policy and procedure, as well and manual writer, contract writer, adherence to local, state and federal laws. Management of personnel. Good with time management and office delegation of tasking in any project. Good phone skills and communication skills on laymen or professional level. Education in prior authorization in insurance billing, prior authorization and denial claims, as well as over seeing choices in health care plans. Works well with physicians and have great knowledge base from Emergency room experience with ability to stay calm in stressful situations. Ability to diffuse situations that may have gotten out of control. Analytical thinking on projects to the next level to find and resolve a problem or complete a task. Willing to give 110% which maybe a fault of my own at times. Documentation has always been a strong part of my job sense and ethic and morality. I believe it any task I am given and will give it all that I have. Never afraid to ask for help on any task when help is needed. Authorized to work in the US for any employer

Work Experience

Dr. Robert Reeves Jr

Dr. Robert Reeves Jr. M.D

October 2010 to October 2013

L.P.N -Manager

• Cared for patients experiencing acute mental distress or who have a mental illness and or substance abuse.

• Documented observations and changes in patient's condition and reported any noted change in patient's condition.

• Collaborated with health team members to facilitate positive patient care outcomes.

• Ensured the correct administration of medication, including injections, and monitoring the results of treatment.

• Responded to distressed patients in a non-threatening manner and attempting to understand the source of distress.

• Applied deescalation techniques to help patients manage their emotions and behaviors.

• Prepared and participated in group therapy sessions.

• Encouraged patients to take part in occupational therapy where appropriate. Assembler

May 2004 to June 2005

-Dept. 740 code 805

• Operated automated equipment to assemble and inspect a variety of products. tow motor license Dr. Robert Reeves Jr

Dr. Robert Reeves Jr. M.D

March 2001 to May 2004

L.P.N.- Manager

• Assisted health care providers and allied health professionals with examinations, treatments, special tests and routine procedures.

• Obtained patient health history, laboratory specimens, vital signs and administers TB skin tests.

• Reviewed patient chart; records and reports observed symptoms, reactions, treatments, and changes in patient's conditions.

• Scheduled and coordinated paperwork for patient transfers to medical facilities or outside health care providers.

• Implemented health care practitioners orders and documents all patient contacts using the POMR format.

• Practiced safety, environmental and infection control methods. Performed additional duties as assigned. Wrote policies and procedures, and manuals for office setting. Assisted in Audit with the DEA, Medical Board, and Pharmacy Board, with the writing and changing of policies to meet the need L.P.N -Emergency Room-Utilization Quality Review Compliance Nurse Firelands Regional Medical Center

September 1977 to June 2000

• Monitored patients in intensive care units and emergency rooms.

• Evaluated and implemented the patient health care plans.

• Evaluated and assessed patient condition in trauma situations including motor vehicle accidents and gunshot/stab wounds. vital signs and documentation of records/triage filing/emergency audits for quality assisted with procedures trauma non-sterol and sterol set up

• Provided an initial assessment, stabilization and care to critical patients.. Reviewed Patients while inpatient and reviewed with insurance companies to show medical necessity for care and corporate compliance and quality review with audits

Education

Bachelor's in Nursing/Business Management

Sandusky School of NursingBGSU/Toledo - SanduskyToledo Ohio May 1980 to November 2008

Skills

• Customer service

• Data entry

• Specimen collection / processing

• Clinical laboratory experience

• Microsoft Office

• Computer networking

• Office experience

• Medical collection

• Driving

• Typing

• Sales

• Group Therapy

• Social Work

• EMR Systems

• Triage

• Case Management

• Individual / Group Counseling

• Medical Billing

• Infection Control Training

Certifications and Licenses

State of Ohio Private investigator/Security Guard

February 2021 to February 2022

Security Courier for Deitrch LLC in Sandusky, Ohio 44870 Additional Information

Worked for bail bonds as private investigator and security guard for Cedar Fait Amusement Park Cedar Point as Security Officer 2 years continuing to go onto to The Sandusky Police Academy at age 66 as a woman.



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