Prior Authorization Data Entry

PAMELA CRUZ

********@*****.*** 214-***-**** Springfield, IL 62707

Talented Prior Authorization Representative with years of implementing strategies to secure authorizations for clinical procedures. Expert delivering continuous clinical quality improvement. Superb influencing skills to communicate with credibility, tact and diplomacy. Dependable Prior Authorization Specialist with a career spent handling various administrative responsibilities in fast-paced settings. I am dedicated to finding solutions to issues and obtaining prior authorization information for patients. Ready to tackle new challenges in an office-based environment. Authorizations

Records Maintenance

Knowledgeable in Epic, SharePoint

Proficiency in [Software]

Insurance procedures

Medical Terminology

Medical Coding

Billing Procedures

Effective communication skills

Patient Referrals

Patient Scheduling

Claim research

Precertification requirements

Insurance Verification Specialist

Understanding of medical terms

Medical billing procedures

Understanding of insurance details

Outpatient surgery coding

Medicare and Medicaid knowledge

Benefit Coverage

Medical terminology knowledge

Data Entry

Private insurance

Retro-Authorizations

Critical thinking abilities

Prescription Coordination

Physician order verification

Workflow Management

Prior Authorization Specialist St Johns Hospital and Clinics - Springfield, IL 04/2024 - 06/2024 Reviewed prior authorization requests to ensure accuracy and completeness of required information. Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services. Provided guidance to providers regarding the prior authorization process. Transplant Financial Coordinator Medical City Dallas Hospital - Dallas, TX 12/2011 - 02/2019 Collected demographic information and income on Heart Transplant candidate in order to secure the financial cost for medications, deductibles, and copay are affordable in order to maintain the organ. I obtained prior authorization and precertification with the patient's health insurance plans for pre- and post-care. I worked with the physicians and transplant surgeons and nurses, and case managers, whom I reported all information regarding the candidates' insurance approvals for transplant services. ATI Career Institute Dallas, TX 02/2007

Associate of Arts: Clinical Massage Therapist

Summary

Skills

Experience

Education and Training

Golf

Reading

Exercise and meditation

Top Collector when I was a Patient Financial Counselor CMS Certificate

References available upon request.

Activities and Honors

Accomplishments

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References

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