Supervisor Prior Authorization Specialist

JULIE KEMP

PRIOR AUTHORIZATION & MEDICAL

INSURANCE VERIFICATION

********.****@*****.*** • 219-***-****

Chesterton, IN 46304

PROFILE

Healthcare professional with 7 years of

experience in prior authorization,

insurance verification, and referrals.

Proven success in leading and

coordinating operations to achieve

higher standards of efficiency and

accuracy. Excellent communication skills

enabling the cultivation of solid

relationships with staff, patients, and

insurance representatives.

AREAS OF EXPERTISE

● Payer Medical Policy Guidelines

● Authorizations and Verifications

● Investigations and Reviews

● Leadership and Scheduling

● Customer Service

● Multi-tasking and Prioritization

● Medical Terminology

● AthenaOne, Epic

● CPT and ICD-10 Codes

● MS Office Suite

EDUCATION

Electronic Health Records

Management Degree

Ashworth College, 4.0 GPA

Certified Electronic Health Record

Specialist, NHA

PROFESSIONAL EXPERIENCE

Precertification Specialist - Lead, 10/2018 to 8/2022 Centers for Pain Control, Valparaiso, IN

Supervised and guided department operations with responsibility for the leadership of 4 direct reports to ensure timely authorization submission, processing, and management of all major procedures, including Intracept, Spinal Cord Stimulator, Vertaflex, ViaDisc, and MILD.

● Guaranteed adherence to deadlines through prioritization and delegation of tasks to team members.

● Ensured compliance via ongoing review of charts, CPT, and ICD-10 diagnoses.

● Executed eligibility and benefit investigations, payer denial and initiates appeals, and peer-to-peer reviews.

● Navigated relationships with key stakeholders including patients and insurance companies.

● Earned quick promotion to Lead due to restructuring of workflows leading to simpler and more streamlined authorization submittal processes. Precertification Specialist and Front Desk Manager, 6/2016 – 9/2018 Jacob’s Ladder, Chesterton, IN

Managed 100+ inbound patient calls per day to schedule occupational, speech, and physical therapy sessions for children with special needs. Coordinated prior authorization processes with accountability for benefit investigations, monthly eligibility reviews, submittal of clinical information, and payment collection.

● Received Pillar Service Award for doubling evaluations revenue from first point of contact and overseeing the entire process.

● Introduced a new pre-visit process that increased volume and decreased denials.

Referrals Coordinator, PSR, 9/2015 – 3/2016

Healthlink, Michigan City, IN

Processed outgoing specialist referrals initiated by the primary care provider, while scheduling patients, maintaining demographic and clinical documents in the EMR, and submitting payer authorizations for MRI and CT imaging.

Contact this candidate