Prior Authorization Authorizations
Resume:
Shannon Griffith, CPC
*** ******* **, ******, ** 25541
*******.********@*******.***
Objective:
Medical Prior Authorization Specialist with billing and ICD10 and CPT coding experience of over 10 years. Extensive knowledge in writing and following up on Government Sponsored as well as Commercial insurance plan authorizations, as well as appeals and revenue recovery (all steps up to and including payment posting from the insurance payor as well as the patient & refunds when necessary), and retro authorizations. Proficient in the use of Epic, Sorian HER, AllScripts and Dragon. Expert use of all Microsoft Office applications including extensive Excel experience. Active AAPC CPC credentials since 2019.
Professional Experience
August 2023 – August 2024 CareFirst BlueCross Blue Shield Charleston, WV
Prior Authorization Advocate I
• Answering provider or third party companies and patients pertaining to prior authorizations in multi-specialties including Primary Care, Radiology, Oncology, Cardiovascular, Thoracics and Genetic Testing to name a few specialties
• Provides benefit information pertaining to coverage of procedures and allowances, as well as patient estimated financial responsibility depending on CPT codes and ICD10 Codes as well.
• Working authorization denials and appeals and retro authorizations in a timely manner to make sure providers receive maximum reimbursement.
• Working daily workload that is uploaded in Excel to keep up to date information, as well as tracking authorization processes. Making sure spreadsheets are up to date and current and accurate.
May 2023 – August 2023 St. Mary’s Medical Center Huntington, WV
Prior Authorization Representative
• Ensured prior authorizations were submitted in a timely manner to obtain optimal reimbursement for testing & procedures. Primarily responsible for conducting, completing, and following up on necessary third-party prior authorizations to ensure patient is taken care of as quickly as possible.
• Submitted prior authorizations for the clinical areas: Cardiac Electrophysiology, Cardiovascular and Cardio Thoracic.
December 2022 – May 2023 The Judge Group (Remote) Pittsburgh, PA
HCC/Risk Adjustment Coder
• Review and analysis of provider documentation with an eye toward compliance with CMS and AMA rules and regulations to capture risk adjusting (HCC) diagnoses
• Complies with all aspects of coding, abides by all ethical standards, and adheres to official coding guidelines of CPT Codes as well as ICD9/10 Codes
August 2022- December 2022 RevMax Pro (Remote) Plano, TX
Client Representative
• Revenue recovery for start-up; using hospital EMRs as reference for missing revenue due to denied claims, obtaining retro authorizations for provider reimbursement using coding guidelines as well as timely filing requirements.
• Resubmitting denied claims once authorizations were obtained to payors and following with timely filing was adhered to
June 2021 – August 2022 Cloudmed (Remote) Plano, TX
Revenue Recovery Analyst II
• Submitted, resolved and followed up on rejected Government Sponsored insurance claims
• Extensive knowledge in Epic systems
• Wrote high level appeals, exhausting all levels of appeals for prior authorizations and retro authorizations
• Utilized CMS, UB, and HFCA forms
June 2020 – June 2021 Excite Health Partners (Remote) Timonium, MD
Pharmacy Prior Authorization Representative
• Ensured optimal reimbursement for high-cost injectable medication. Primarily responsible for conducting, completing, and following up on necessary third-party prior authorization requests for high-cost medications.
• Submitted prior authorizations for all Specialty medications in the following clinical areas: Oncology, Hematology and Orthopedics.
April 2019 – June 2020 West Virginia Eye Consultants Charleston, WV
Billing Coordinator
• Submitted bills, audited claims, and obtained prior authorizations for procedures.
• Coded all procedures using the latest CMS and AMA guidelines.
• Responsible for applying reimbursement payments from insurance payors and patients, including refunds to patients and/or insurance payors
April 2017 - March 2019 U.S. Department of Veterans Affairs Huntington, WV
Medical Records Technician (Coder)
• Responsible for all coding using latest CMS & AMA guidelines.
• Responsible for classifying medical data in their appropriate clinical settings.
June 2016 – April 2017 Huntington Internal Medicine Group Huntington, WV
Prior Authorization Representative
• Responsible for obtaining prior authorizations for Oncology and Hematology patients as well as other specialties using CPT Codes and ICD9/10 Codes with proper documentation for optimal reimbursement for providers.
• Experienced in using CMS & AMA Guidelines, as well as adherence Coding and Diagnosis guidelines
Education:
Associate in Applied Science Huntington Junior College Huntington, WV
Graduate 2017
3.59 GPA
AAPC Certified Professional Coder ID 01750376 aapc.com
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