Authorization Specialist Customer Service
Resume:
DONA M. RICHBURG
Uniondale, NY **553
Phone: 516-***-****; Email: *************@*****.*** OBJECTIVE
To obtain a position where I can maximize my multilayer of management skills, quality assurance, program development, training experience, customer service, and a successful track record in the healthcare environment
PROFESSIONAL EXPERIENCE
CVS QUALITY Sacramento, CA 2017 - Present
Authorization Specialist (Remote)
Obtains and maintains all required authorizations for patients.
Contacts physician offices and insurance companies to obtain and provide necessary patient detail to ensure prescription approval
Contacts insurance companies and escalates issues when approvals are not timely and/or received
Notifies patients of pending expirations and coordinates prescription renewal as appropriate
Maintain account work progress, including but not limited to updating authorization logs, account referral in EMR, authorization paperwork and issue reports
Assists the patients with the completion of their paperwork
Cooperate, coordinate, and collaborate with clinical staff and Revenue Cycle Operations staff to resolve patient relationship
Maintain insurance authorizations for current patients
Re-verify insurance coverage for changes in medication orders
Research and follow up on authorization denials
Work closely with branch staff to collect additional information on Physician Orders
Scan and upload documents from insurance providers into electronic records system and notify appropriate departments
Knowledge of Medicare/Medicaid claims, as well as Workers' Compensation and No Fault
Experience with out-of-network billing/collections for all commercial carriers
Excellent verbal and written communication skills
Attention to detail and timely follow up skills
Submit changes to patient prescriptions in the system and obtain authorization for payment
Dona Richburg Page 2
ARMOR CORRECTIONAL HEALTH SERVICES East Meadow, NY 2016 – 2017 Medical Secretary
Under indirect supervision, provides independent primary care in a correctional setting to a specified population of non-emergency patients
Provide consultation and advice to others
Perform medical examinations and evaluations, diagnoses, treatment, follow-up consultation and health education
Manage patient's overall care
Obtain patient histories and develops patient care treatment plans, ensuring completeness and accuracy using the POMR format
Supervises and/or coordinates the activities of patient care and/or support staff
Diagnose and treat acute and chronic conditions.
Prescribe medications and other treatments
Participate in planning programs and in developing specific health policies and procedures
Practice safety, environmental and/or infection control methods
Adhere to Armor's Standards of Professional Conduct PERKIN ELMER LABORATORIES Melville, NY 2015 – 2016 Medical Biller
Respond to inbound patient, client and field sales calls in a timely, sensitive and professional manner
Resolve and follow patient, client and field sales issues to conclusion, own problem resolution through account research and interpretation
Escalate caller issues that cannot be resolved at the Representative level to billing management team members
Document all call history in call logging system to established procedures
Make required outbound calls as needed (to patients and clients)
Update and resubmit claims as needed
Return voicemail messages
Set up patient payment plans according to established criteria
Apply insurance updates for accurate claim submission
Process and create forms and letters (reproduce statements, apology letters, etc.)
Respond to patient and client emails and correspondence within required timeframes
Handle patient and client inquiries via email from NTD website
Process credit card payments from patients
Communicate within team and across functions as needed Dona Richburg Page 3
APRIA HEALTHCARE Plainview, NY 2012 - 2015
Customer Quality Specialist
Verify insurance information for accuracy and completeness and resolves discrepancies as needed
Obtain clinical information needed for order processing or reimbursement
Contact patient to advise them of the order placed on their behalf and to confirm all patient demographic information
Communicate any financial responsibilities and/or additional information necessary for processing the order received
Promote other company product and services, as appropriate
Process information received from intake/service personnel
Ensure proper selection of information online to ensure timely delivery and appropriate revenue recognition for order
Maintain appropriate documentation received with order and conducts follow-up as applicable
Demonstrate professional etiquette and courtesy when interfacing with customers
Resolve patient/customer complaints by identifying problems and coordinating appropriate corrective action
Comply with and adhere to all regulatory compliance areas, policies and procedures, and
'best practices'
SKILLS
Microsoft XP, Word, Excel, IDX, Dictaphone
EDUCATION
Bryant University Medical Coding & Billing A.A.S. 12/2018
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