Prior Authorization Administrative Assistant
Resume:
H
Kendra
Holmes
**********@*****.**
m
Woodstock, GA 30189
SUMMARY
Empathic, effective and motivated professional who combines years of clinical and business management experience with the compassion to meet the changeless facing today's healthcare organizations. Clear awareness of diverse backgrounds, alert to widely varied patients' needs and circumstances. Collaborative team player, acting as key resource to colleagues and allied professionals.
SKILLS
Team Player
Strong Organizational skills
Attention to detail
Excellent time management skills
Ability to interact effectively with
patients / families
HIPAA Compliance
CPR Certified
Friendly and Outgoing
Multitasking
Extensive Knowledge of Understanding
Insurance Explanation of Benefits
Optimistic
Interpersonal skills
Knowledge of Excel
Power Point
Microsoft Word
Advantage Software
Encircle Software
Availity
One Source
Experience working with a Specialist
Physician Office
Preparing Bank Deposits
Reviewing and explaining Insurance
Benefits
EXPERIENCE
Administrative Assistant
Marietta, GA
The Physicians Spine and Rehabiltation/ Mar 2023 to Current Experience working for a Specialist Physician's office Reviewed prior authorization requests to ensure accuracy and completeness of required information.
Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
Coordinated with other departments to obtain additional information needed for prior authorization.
Provided guidance to providers regarding the prior authorization process. Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
Researched clinical criteria and determined eligibility for requested services based on plan provisions.
Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
Facilitated communication between providers, payers and health plans regarding prior authorization processes.
Ensured compliance with state and federal regulations pertaining to prior authorizations.
Identified areas where improvements can be made within the department by analyzing trends in denials and approvals.
Advised provider offices on proper coding practices that are necessary for successful claim submission.
Interpreted benefit language in order to determine covered services under each plan type.
Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
Researched third party payer guidelines related to prior authorizations, coding and billing processes.
Responded promptly to customer inquiries regarding their benefits and eligibility status.
Updated patient and insurance data and input changes into company computer system.
Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
Answered telephones and directed calls to appropriate medical or adminstrative staff. Scheduled and confirmed patient appointments and consultations. BUSINESS OFFICE SPECIALIST/ FLOATER
HCA/ Feb 2019 to Mar 2021
Surgery and GI scheduling: scheduling surgeries for multiple Surgeons and Gastroenterologists: In constant communication with outside schedulers for different equipment that maybe needed for surgeries
Front desk admissions: Patient registration / admission for same day surgery Chart preparation
Entrusted with bank deposits and cash closing
Medical records clerk: scanning charts into EMR
Chart auditing and peer review
I was coverage for co-workers that had a day off, vacations, call outs and etc… Most days I did all three jobs in the same day.
GI TECH
HCA/ Aug 2009 to Feb 2019
Setting up procedure rooms for Colonoscopies, EGDs, and Small Bowel Enteroscopies: Assisting Physicians with polyp removals, random biopsies and dilations Specimen handling, cleaning and processing of scopes. SURGERY SCHEDULER
HCA/ Apr 2007 to Jul 2009
Surgery scheduler for over 30 surgeons: In constant communication with outside schedulers for different equipment needed, block times and daily changes made to schedule.
FRONT DESK ADMISSION
HCA/ Dec 2005 to Jul 2007
Patient admission for same day surgery
Chart preparation
Entrusted with bank deposits and Cash closing
Allocation of Co-pays and prepares the deposit bag for accounting. EDUCATION AND TRAINING
Medical Assistant
BRYMAN COLLEGE
High School DIPLOMA
JOHN F.KENNEDY
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