Prior Authorization United States

DEVIN HAYES

Hoffman Estates, IL ***** • 206-***-**** • **********@*****.***

Professional Summary

Detail-oriented team player with strong organizational skills and cross-functional in all health related areas such as Trauma, Prior Authorization and Case Management. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Skills

• ICD-9 and ICD-10 Coding

• Epic

• Trauma informed care

• Cognitive Behavioral Therapy

• Community Presentations

• Crisis Management

• Individual services

• Group services

• Children and Families

• Suicide Risk Assessment

• Psychological Assessment

• Problem-Solving

• Teamwork and Collaboration

• Time Management

• Problem-solving abilities

• Excellent Communication

• Patient Education

• Analytical Thinking

• Task Prioritization

• Various Electronic Medical Record Software

Work History

Eligibility and Prior Authorization Specialist, 05/2024 to 08/2025 Natera – Los Angeles, United States

• Expedited treatment commencement by promptly acquiring authorizations for medically necessary services within required timeframes.

• Assisted clients with accurate eligibility form, application and document completion.

• Enhanced interdepartmental collaboration through effective communication with case managers, physicians, and billing departments.

• Analyzed trends in denials or authorization delays to identify opportunities for improvement within the precertification department.

• Maintained strict adherence to HIPAA regulations by safeguarding confidential patient information during all aspects of the precertification process.

• Scheduled appointments with applicants to gather information and explain benefits processes.

• Trained staff on current eligibility requirements and policies.

• Assisted with medical coding and billing tasks.

• Received and routed laboratory results to correct clinical staff members. Lead Prior Authorization Specialist/Financial Navigator, 09/2021 to 05/2024 Kindbody – Chicago, United States

• Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.

• Assisted in the development of departmental guidelines and procedures for prior authorization processes, improving overall efficiency.

• Tracked referral submission during facilitation of prior authorization issuance.

• Researched denied claims and contacted insurance companies to resolve these issues.

• Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.

• Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.

• Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.

• Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.

• Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.

• Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.

• Participated in cross-functional initiatives to improve overall efficiency and effectiveness of the prior authorization process for all involved parties.

Trauma Care Coordinator, 03/2012 to 06/2018

Northwestern Medicine – Chicago, United States

• Provided crisis and short term therapy to survivors of sexual violence and those who support them. Individual and group services provided beginning 3 years of age.

• Presented information to community agencies to increase the understanding of trauma informed care and services.

• Served as a liaison between hospital administration and clinical staff to address ongoing needs within the trauma program.

• Collaborated with local emergency medical services to improve pre-hospital care for trauma patients.

• Assisted in maintaining certification standards set forth by regulatory agencies, ensuring compliance with all requirements.

• Coordinated multidisciplinary team efforts to ensure efficient patient care during trauma situations.

• Provided education and training opportunities to hospital staff on current trends in trauma management, fostering a culture of continuous learning.

• Implemented injury prevention programs within the community to reduce instances of traumatic injuries requiring hospitalization.

• Built strong relationships with patients and families for optimized care satisfaction.

• Led physicians, nurses and healthcare teams in providing punctual, professional care delivery.

• Communicated with patients, ensuring that medical information was kept private. Education

Bachelor of Science: Health Administration, 05/2015 National Louis University - Chicago, IL

• 4.0 GPA

• Academic Distinction Member

Certified Nursing Assistant: Nursing, 10/2010

Malcolm X College - Chicago, United States

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