RESUME

GA

PERSONAL PROFILE

Results-driven healthcare professional seeking a challenging role as a Pre-certification and Authorization Representative, Clinical Reviewer, Patient Access Specialist, Specialty Rx Liaison, or Case Management Specialist. Leveraging a strong background as a dedicated Ophthalmology Technician with extensive experience in providing exemplary patient care, navigating complex prior authorization procedures, and successfully overseeing pharmacy operations. Proficient in conducting thorough clinical reviews, securing authorizations, and streamlining patient access processes. Demonstrated expertise in optimizing administrative workflows, enhancing documentation practices, and improving overall operational efficiency. A committed and detail-oriented professional, poised to contribute exceptional skills and knowledge to ensure the highest standards of care and compliance in the healthcare industry. STRENGTHS & CAPABILITIES

Conduct comprehensive clinical reviews to assess the medical necessity of procedures and treatments.

Analyze medical records and documentation to ensure compliance with guidelines and regulations.

Skilled in coordinating appointments, obtaining referrals, and ensuring timely access to healthcare services.

Manage the unique requirements of specialty medications and assist in securing funding or assistance programs.

Proven experience in case management, coordinating care plans and ensuring continuity of patient care.

Strong skills in maintaining accurate and detailed medical records, ensuring compliance with regulatory standards.

Excellent communication skills, adept at collaborating with healthcare providers, insurance companies, and other stakeholders.

Develop strategies to overcome barriers and optimize patient outcomes. PROFESSIONAL EXPERIENCE

Northeast Wisconsin Retina Associates 2012 - present Ophthalmology Technician March 2017 – present

Initiated accurate documentation of the patient's primary concerns, present illness history, review of systems, and relevant ocular findings.

Conducted various tests, including visual acuity measurements, tonometry, confrontation visual field testing, and pupillary function assessments.

Administered both topical and oral medications under the direction of the physician.

Performed OCTs and Fluorescein Angiograms.

Participated in intraocular injections, laser treatments, and other in-office procedures.

Maintained and ensured the proper functioning of instruments and equipment.

Closed exam lanes daily, ensuring appropriate disinfection and proper placement of battery- powered instruments in recharge wells, as well as the readiness of slit lamp examination equipment.

Educated patients on medication administration and provided pre- and postoperative/procedure instructions as directed by the physician.

Handled prescription refill requests and e-prescribing as authorized by the physician.

Managed inventory and reported medication and medical supply needs.

Ensured proper cleaning and disinfection of equipment and instruments.

Collaborated and communicated effectively with other departments.

Provided additional patient services upon request.

Obtained referrals and prior authorizations for injection and surgical cases as needed. Clinic Coordinator Dec 2014 - March 2017

Streamlined schedules for physicians across all four clinic locations for optimal efficiency.

Coordinated surgical activities among physicians, hospitals, and various clinic sites.

Generated surgical orders and provided preoperative instructions for physicians, hospitals, and patients.

Assessed insurance eligibility, benefits, and secured referrals and prior authorizations.

Identified non-covered services and obtained Advanced Beneficiary Notice (ABN) from patients.

Played a role in collections and facilitated applications for financial assistance, ensuring seamless communication of crucial financial and insurance details between front office and business office staff.

Supervised and directed the tasks of medical administrative assistants. Contact

Ophthalmology Technician

Prior Authorization Specialist

Documentation Management

Pharmacy Lead

Retinal Technician

Vision Screening

Specialty Pharmacy Funding

Retinal Imaging

Case Assessment

Resource Allocation

Procedure Assisting

Delivered Care

Generated Documentation

Improved Processes

Performed Testing

Administered Medications

Developed Strategy

Obtained Authorizations

Drove Growth

Customer Service

Communication Skills

Multitasking

Problem-Solving

Computer Proficiency

Confidentiality Maintenance

Cultural Competence

920-***-****

ad2mo7@r.postjobfree.com

Weston, WI 54476

Rebecca Schultz

Professional Skills

RS

RESUME

Medical Administrative Assistant Oct 2012 - Dec 2014

Accurately inputted, assessed, and updated current insurance, demographic, and financial information in practice management and electronic medical records software.

Conducted assessments of insurance eligibility, benefits, and secured referrals and prior authorizations.

Identified non-covered services and acquired Advanced Beneficiary Notice (ABN) from patients.

Scheduled both appointments and surgeries.

Monitored neonatal ICU appointments, tracked missed appointments, and managed broken treatment schedules.

Collected copays and outstanding balances, providing assistance with applications for financial aid.

Prepared electronic medical records, related correspondence, and fulfilled medical record requests. Aurora Health Care Patient Account Representative Sep 2011 - Oct 2012

Provided prompt, courteous, and helpful guidance to patients and visitors.

Addressed patient inquiries about their accounts and screened calls via telephone.

Managed the patient check-in process.

Ensured completion of all necessary forms by patients and obtained demographic and insurance information, verifying insurance coverage.

Collected co-pays, deductibles, and previous balances, and updated online registration and insurance information as needed.

Orchestrated payment arrangements for outstanding balance files in adherence to clinic policies.

Offered advice to patients regarding financial options within the community.

Negotiated and established payment plans as necessary. Miles Kimball Telephone Sales Representative Oct 2009 - June 2011

Oversaw incoming sales and status calls, along with catalog requests for various divisions, meeting established quality and productivity standards.

Delivered a comprehensive shopping experience to customers.

Maintained a high level of product knowledge.

Aurora Health Care Customer Service Representative Float June 2005 - Sep 2011

Provided departmental support by welcoming and registering patients, completing required forms, and gathering demographic and insurance information.

Collected patient co-pays, processed payments, and updated patient file details.

Served as the primary point of contact for patients and visitors upon their arrival at the clinic. PRIOR EXPERIENCES

PRN Health Services, Dialer

TECHNOLOGIES & CERTIFICATIONS

Technologies: Microsoft Office Suite, MD Suite, MDI

Education: Registered Nurse, Certified Nursing Assistant, Fox Valley Technical College

Contact this candidate