Prior Authorization Customer Service
Resume:
HEATHER OGBURN
Evans, GA *****
623-***-**** – *********@*****.***
PROFESSIONAL SUMMARY
Detail-oriented and dependable Medical Receptionist with the ability to manage multiple administrative tasks in a fast-paced environment. I am seeking to join a reputable organization where I can successfully apply my strong skill sets in customer service and overall office duties. SKILLS
* Customer Service Orientation * HIPPA/OSHA Compliant
* Multitasking Capabilities * Telephone/Patient Scheduling Etiquette
* Workflow Management * Documentation and Paperwork
* Effective Communication Skills * Insurance Verification/Prior
* Organizational Skills/Attention to Detail Authorizations/Denials
* Professionalism and Ethics * Payment Collections/Invoices WORK HISTORY 02/2018 to 01/2024 Administrative Support Specialist and Prior Authorization Manager First Approve, LLC/Consultative Genomix – Evans, GA
* Managed a high volume of incoming and outgoing calls from patients and providers.
* Verified eligibility/benefits and prior authorization requirements.
* Accurately input all patient information into the practice management system.
* Collaborated with physicians to obtain all necessary clinical information for prior authorization submissions.
* Submitted prior authorizations to Insurance companies with accuracy and performed follow-up when needed.
* Assisted in the development of departmental guidelines and procedures to improve the overall efficiency of the prior authorization process.
* Maintained thorough knowledge of Insurance plan requirements and detailed understanding of medical necessity criteria and provided training to all staff members.
* Coordinated with the billing department to resolve denied or unpaid claims.
* Researched denied claims and contacted Insurance companies to resolve these issues.
* Reviewed prior authorization denials and communicated with payers to issue appeal. 06/2014 to 02/2018 Receptionist/Chiropractic Assistant Haggard Chiropractic – Phoenix, AZ
* Managed daily operations of the office, ensuring a smooth workflow for patients and staff.
* Maintained strict adherence to HIPPA/OSHA regulations.
* Greeted all patients at check in and check out.
* Answered a high volume of incoming calls and maintained proper patient scheduling.
* Accurately input all patient information into the practice management system.
* Collected payments and maintained accurate financial records for the practice.
* Sent invoices for services rendered.
* Prepared examination rooms with all necessary equipment, promoting efficient appointment flow.
* Assisted doctor with patient care, treatment plans, and accurate documentation.
* Contacted insurance carriers to verify patient eligibility and benefits.
* Reviewed all patient chart notes and assisted with all unpaid claims to rectify billing issues. 11/1999 - 05/2014 Chiropractic Office Manager/Billing Specialist AZ Fitness Chiropractic – Glendale, AZ
* Managed daily operations of the office ensuring compliance with all necessary regulations.
* Maintained strict adherence to HIPPA/OSHA regulations.
* Greeted all patients at check-in and check-out and maintained accurate patient scheduling.
* Answered a high volume of incoming and outgoing calls and
* Maintained accurate patient scheduling.
* Accurately input all patient information into the practice management system.
* Contacted insurance carriers to verify patient eligibility and benefits including all specifics.
* Monitored patient accounts to identify and rectify billing issues.
* Sent monthly invoices and generated monthly billing and posting reports for review.
* Electronically submitted billing and provided follow-up to address any issues promptly.
* Processed and assisted with posting Insurance payments and assisted with all EOB questions.
* Assisted doctor with patient care, treatment plans, and accurate documentation. CERTIFICATES Dale Carnegie Leadership Certificate
12-week course focusing on communication, leadership and Interpersonal skills both professionally and personally.
EDUCATION 08/1999 to 05/2000 Front Office/Back Office
Long Medical Institute - Phoenix, AZ
08/1996 to 05/1999 General Studies/Undergraduate Prerequisites Arizona State University – Tempe, AZ
08/1993 to 05/1996 High School Diploma
Kingman High School – Kingman, AZ
REFERENCES Available upon request
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