L

Heather

Labine

413-***-****

adt9qg@r.postjobfree.com

Westfield, United

States 01085

SUMMARY

Detail-oriented Prior Authorization Specialist proudly offering over 22 years' experience managing medical documents meticulously. Polished professional known for working closely with insurance companies to alleviate denied claims and obtain necessary prior approvals for services. Multitasks expertly in fast-paced environments. Offering a keen understanding of the latest insurance requirements for prior authorizations. Determined Prior Authorization Specialist boasting extensive claim researching and effective collaboration skills with other members of the office staff. SKILLS

• Understanding of medical

terminology, procedures and coding

• Knowledgeable in HCHB

• Precertification requirements for 90

different insurance policies

• Insurance information oversight

• Recordkeeping and data input

• Conflict resolution

• Experience with EMR

• Experience with high call volume

• Friendly, positive attitude

• Troubleshooting denials and submit

appeals as needed

• Medicaid knowledge

• Electronic authorization processing

• Insurance plan verification

• Prebill audits

• Customer service experience

• Medical records documentation

review

EXPERIENCE

Managed Care Coordinator / Authorization Specialist Charlton, MA

Overlook Visiting Nurse Association - Jan 2002 to Current

• Contacted insurance companies to obtain necessary authorizations for home care and hospice

• Contacted insurance carriers to obtain authorizations, notifications and pre- certifications for patients.

• Provided accurate information to all parties, including insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.

• Coordinated resolutions for issues and appealed denied authorizations.

• Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.

• Performed detailed medical reviews of prior authorization request, following established criteria and protocols.

• Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.

• Used HCHB to input claim, prior authorization and other important medical data into system.

• Maintained files for referral and insurance information, entering referrals into system.

• Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.

• Collaborated with internal departments to provide account status updates.

• Adhered to regulatory guidelines for workplace safety and customer confidentiality.

• Transmitted claims to insurance companies for payment and reconciled EOBs.

• Updated spreadsheets and other document filing

• Wrote and updated operational procedures for department of five people.

• Displayed strong telephone etiquette, effectively handling difficult calls.

• Reviewed accounts for signs of fraud and non-payment issues.

• Verified that patients had proper insurance coverage prior to admitting.

• Updated patient and insurance data and input changes into company computer system.

• Checked documentation for appropriate coding, catching errors and making revisions.

• Entered data in EMR database to record payer, authorization requirements and coverage limitations.

• Navigated through multiple online systems to obtain authorization.

• Retained strong medical terminology understanding in effort to better comprehend procedures.

• Performed verification of Medicare coverage.

• Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.

• Maintained up-to-date understanding of insurance payment practices.

• Reviewed claims for accuracy before submitting for billing.

• Sent clinical request and missing information to appeal denials.

• Reviewed administrative guidelines whenever questions arose during processing of claims.

• Remained current on latest industry trends by gaining comprehensive knowledge of financial and insurance products, services and best practices.

• Collaborate with Physicians, Clinicians and patient regarding documentation needed, and to help assist them with any issue they may have

• Handle heavy call volume

EDUCATION AND TRAINING

Master of Science: Health Administration

Kaplan University Aug 2015

Davenport, IA

Bachelor of Arts: Business Administration

Kaplan University Aug 2013

Davenport, IA

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