Patient Care Prior Authorization
Resume:
ANNA NEGRON
** ************ ****, *******, *** York 10990
**************@*****.***
** ********* *****, *** *, Goshen, NY 10924 (H) 845-***-**** **************@*****.*** Professional Summary
Quality-focused committed to approaching tasks with tenacity and attention to detail, who goes above and beyond basic skills and takes on multiple projects at once. Excellent work ethic and strength in boosting company morale. Highly organized and detail-oriented with more than 10 years’ experience.
Skills
Excellent communication skills, Strong interpersonal skills; EMR, ICD-10, EPIC, NEXTGEN, CERNER, Short Hand, Steno Typist.
Work History
Scheduling Radiology Specialist 11/2021- 01/2024
Westchester Medical/ Bon Scour
• Reviews & monitors all radiology authorization work.
• Calls Patient’s to make appointments for procedures once Prior auth is approved.
• Update health insurance information
• Document event activity using medical, billing & procedure codes
• Use Epic EMR program to complete updates & scheduling.
• Maintaining records of patients payments made to facility . Customer Service Representive 11/2020 -10/2021
Crystal Run Healthcare
• Answers all incoming telephone calls during the course of the normal business day; transfers calls to other departments and personnel as appropriate.
• Ascertains the urgency of all phone calls; is able to appropriately triage and direct urgent and emergent calls according to established procedures to ensure optimal quality patient care.
• Records messages for Physicians and staff; ensures accuracy and completeness of information and timely delivery of messages.
• Contacts Physicians working off-site if necessary to ensure timely delivery of urgent messages.
• Schedules appointments for urgent problems, communicates and coordinates scheduling with clinical personnel to optimize patient care and efficiency.
• Schedules new patient appointments; obtains appropriate information, assists the patient in choosing a Physician when necessary, enters preliminary account data into computer, confirms primary care status/insurance eligibility as needed, communicates payment expectations to patient.
Prior Authorization Specialist 01/2020 – 10/2021 ( per diem) Dr. Mantica Ortho Surgeon
• Discuss medications, insurance, and prior authorization documents with patients.
• Get prior authorization approval from insurance firms.
• Appeal insurance companies after prior authorization refusals.
• Assess accounts for completeness and accuracy.
• Follow up on missing or incorrect information so patients receive the right reimbursement.
• Document account activity using correct medical and billing codes.
• Setting up Peer to peer with physician & insurance physician.
• Used EPIC EMR for daily authorization duties.
• Clerical Duties
• Maintaining records, receiving payments for patients & keeping financial Pharmacy Technician 04/2019-11/2020
The Sentinel of Port Jervis Assistant Living
o Giving scheduled drugs.
o Giving ordered PRN (as needed) medications after checking with residents Doctor.
o Performing tasks associated with medication administration, including vital signs, height and weight, glucose monitoring, and client observation
o Recording medication administration according to facility procedure o Reporting changes in client status regarding drug therapy to ensure client comfort and safety
o Reporting life-threatening events to the Doctor to protect self, the client, and others
o Reporting drug errors and filling out proper forms o Prepare both physical chart for nursing unit and complete electronic medical record
o Remain available and responsive to hospital social workers to assist with setting up admissions to the facility.
o Review case and obtain authorization from managed care companies. o Complete financial screenings to ensure insurance coverage for the facility. Medical Unit Coordinator 10/2017 to 04/2019-
Elant/Sapphire Nursing Home - Goshen, NY
• Transcribing reports
• Recording medical histories
• Processing patients' insurance
• Taking vital signs
• Ordering supplies
• Dealing with Insurance Companies to help get Prior Authorizations for resident(s) needing out of pocket medical supplies & Medications. Executive Assistant in Sales 07/2009 to 09/2017
TGI Automation – Brooklyn, NY
● Managed external contacts for CEO and kept track of periodic communication needed for priority clients.
● Created expense reports, budgets and filing systems.
● Conducted research to prepare, gather and proof briefing materials, agendas, and decks for all executive-level meetings.
● Processed travel expenses and reimbursements.
● Answered Phones
● Made reservations for sales floor showing.
● Reconciled and processed expense reports for 15 internal and field personnel using Keyboard.
● Taking notes in Short hand or transcribes dictation during corporate meetings.
Executive Assistant & Sales 11/2003 to 06/2009
Blitz/Sound Bytes - Bayonne, NJ
• Working one on one with hearing & speaking impaired clients.
• Connecting devices & training caretakers, clients in how to use TTY phones & other household devices for daily living.
• Helping clients with merchandise orders.
• Processing payments using Check, CC & Cash.
• Dealing with USPS, UPS & FEDEX for shipping of merchandise.
• Meeting with potential clients to show how to use merchandise & closing sale once purchased.
Education
Associate Degree of Applied Science: Pharmacology, Psychiatry, Medical Billing & Coding ; 2009 Mandl College of Medicine - New York, NY
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