Referral/ Prior Authorization Specialist

Summary of Qualifications

●Ambitious, reliable medical professional with strong work ethics possessing the focus and drive to succeed to enhance an employer's practice

●Seeking to utilize the customer service experience, education and training to assist in providing quality patient care.

●Ability to learn new concepts and skills while paying close attention to detail

●Adhere to high standards of personal and professional excellence while developing new methods and creating ideas for more efficient workflow

Data Entry

MS Word, Excel, Outlook

Emportis

Medical Terminology

Medicare

Care Radius

Partial Credentialing

ICD-9 and ICD-10

Administrative Duties

Prior Authorizations

Visual Cactus

Type : 40 WPM

Education

Medical Front Office & Billing Diploma, UEI College, Phoenix, AZ (Mar 2014 to Oct 2015)

Medical Assistant Diploma, Anthem College, Phoenix, AZ (Apr 2009 to Dec 2010)

Employment

Referral Specialist, Centene Corporation, Tempe, AZ (Dec 2018- July 2022)

●Built member authorizations for inpatient stays

● Built and approve outpatient authorizations for observation stays

● Verify member eligibility and provider contracting/credentialing status prior to authorizing

●Built and approved inpatient OBG stays

●Registered newborns with AHCCCS

Provider Data Coordinator, Healthcare Support Services (Centene) Tempe, AZ (Feb 2018-Dec 2018))

●Perform outreach to Providers to verify Practitioners information for online directory.

Authorization and Eligibility Clerk, Retina Associates, Tucson,AZ (May 2017-Nov 2017)

●Verified Patients insurance

●Submitted authorizations for certain services

●Submitted referral authorizations

●Used AMD and MDI software

Provider Data Specialist, TriWest Healthcare Alliance, Phoenix, AZ (Oct 2015-April 2017)

●Partial provider credentialing

●Data Entry

●Make outbound calls to providers for additional information

●Look up provider’s licensing, their name on OIG website, Medicare status

●Facets training

●Worked as a contractor through Aerotek until March 2016 and then was permanently hired on

Member Service Representative, Health Choice, Phoenix, AZ (Mar 2015-Aug2015)

●Answered inbound member and provider calls

●Assisted members with benefit information

●Assisted providers with claim denials and other issues

Customer Service Representative, Terminix, Glendale, AZ (Mar 2014-Mar 2015)

●Answered inbound customer calls

●Set up service calls

●Customer support for billing issues

Data Entry/ Quality Control, Office Team, Long Beach, CA (Oct 2013 to Nov 2013)

●Entered in lab results in to database and all logs into a log tracker.

●Reviewed finished product and entered in all samples for Microbiologist.

Clinical Admin Coordinator/ Intake Coordinator, United Healthcare, Phoenix, AZ (Apr 2013 to Aug 2013)

●Answered inbound members calls.

●Assisted healthcare providers and members with prior authorization requests.

Customer Service Representative, Logisticare, Phoenix, AZ (Mar 2012 to Apr2013)

●Assisted Medicare members with setting up transportation.

Customer Service Representative/ Technical Support, CableOne, Phoenix, AZ (Nov 2009 to Mar 2012)

●Assist customers with setting up new installs for service.

●Customer support for technical issues and billing.

Medical Assistant Extern, 27th Avenue Medical, Phoenix, AZ (Sep 2010 to Dec 2010)

●Successfully completed 256 hours of Front and Back hands-on training in a clinical setting.

●Referrals, vaccinations, scheduled appointment, checked in/out patients, call backs, RX Refills, pulled patient files, Alpha & Numeric filing, familiar with EMR data entry, roomed patients, EKG, took patient vital signs.

●Processed payments via ACH check and debit/credit card

Customer Service Representative, Arizona Wholesale Supply Co, Phoenix, AZ (Mar. 2006 - Aug. 2008)

●Assisted customers with setting up service calls for appliance and replacement items, handled money and credit card transactions and trained new hires.

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