Customer Service Authorization Specialist
Resume:
Nethona Yarbrough, CRCR
Cincinnati, Ohio 45205
*****.*********@*****.***
Profile
Strong oral and written communication skills.
Proven skills in decision-making, conflict resolution and interpersonal relationships in customer service roles. Problem solving and acting as a liaison for patients.
Windows operating systems; Prime Suite, EPIC, Windows 10, Microsoft Word, Excel, PowerPoint, Outlook and One Note. Other systems have experience with CAS, MTV including experience in Calyx, AS400, DU/LP and ACSS databases. Successful work at home associate since 2014.
CRCR Certified
Employment History
Riverhills Neuroscience
Prior Authorization Specialist 07/20 – Present
Making sure that current insurance is active and added to patient’s chart correctly. Working on date sensitive tasks requesting insurance authorization for imaging and/or diagnostic testing. This required accessing all payor portals for submission. Making outbound calls to insurance companies, or outside Doctor’s offices. Checking faxes throughout the day for approvals and following up on pending tasks. After obtaining all required information, add all to EHR. Completed task would be sent to central scheduling to contact patient for scheduling.
UC Health
Insurance Verification/Authorization Specialist 12/19 – 07/20
Verified eligible insurance via OneSource, payer websites and/or via phone. Responsibilities also include obtaining required pre-authorizations for advanced radiology testing at UC facilities payers via web, phone or fax to ensure maximum reimbursement. This entailed reviewing patient’s clinical information relevant to procedure to submit for authorization approval from applicable payers. Payers include but are not limited to BCBS, Aetna, UHC, Humana, Molina, Paramount, Care Source, Medical Mutual and Buckeye.
United Health Group/UMR
Customer First/Claims processor 09/16 - 11/19
This is a two-part position. Answering inbound calls from members, providers and other insurance companies. Providing benefits, claim information, ID cards, and eligibility. Processing claims that are not auto-adjudicated and referring them for payment and/or denial. Accessing multiple computer systems for information and documenting every call and completed claim.
References upon request
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