Authorization Specialist

REBECCA SCHULTZ

HEALTHCARE ACCESS & OPERATIONS BENEFIT VERIFICATION & PRIOR AUTHORIZATION

Weston, WI Cell: 920-***-**** Email: ***************@*******.***

PROFESSIONAL SUMMARY

Experienced Prior Authorization Specialist and Certified Ophthalmic Assistant with 10+ years in ophthalmology and healthcare operations. Skilled in navigating insurance processes, securing timely approvals, and guiding patients with empathy and clarity. Known for improving workflows, supporting clinical teams, and bringing a problem-solving mindset to every task. Grew from front desk to clinical and coordination roles, offering a well-rounded perspective on patient care. Now seeking to expand my impact through leadership, care coordination, or patient access roles.

SKILLS

Prior Authorization Medical Documentation Patient Education Surgical Coordination

Insurance Verification Patient Communication EMR Management Clinical Coordination

WORK EXPERIENCE

AUTHORIZATION SPECIALIST January 2025 – Present

Northeast Wisconsin Retina Associates

●Manage clinic schedules and proactively secure insurance authorizations, financial assistance, and approvals for buy-and-bill procedures and specialty pharmacy medications.

●Coordinate surgical authorizations and lead resolution of denials and appeals, ensuring patients receive timely access to care.

●Maintain accurate documentation and serve as a resource to staff, supporting smooth clinic operations and offering guidance on payer processes and workflows.

●Educate patients on financial resources, including copay assistance and specialty pharmacy enrollment, to reduce out-of-pocket costs and support treatment adherence.

●Collaborate with billing teams to stay current on insurance policies and payer trends, helping reduce delays in reimbursement and align practices across departments.

PRIOR AUTHORIZATION/RETINAL TECHNICIAN March 2017 – December 2024

Northeast Wisconsin Retina Associates

●Secure insurance authorizations for laser procedures and specialty medications, including buy-and-bill and specialty pharmacy processes, to ensure timely and uninterrupted care.

●Coordinate authorizations and lead follow-up on denials and appeals, working directly with payers to resolve issues efficiently and support patient access.

●Perform comprehensive diagnostic testing (OCT, visual acuity, fundus photography) and assist physicians with in-clinic procedures such as intraocular injections and laser treatments.

●Maintain accurate clinical documentation of patient history, ocular findings, and treatment plans in EMRs, supporting compliance and high-quality care.

●Educate patients on treatment expectations and financial resources, including copay assistance and specialty medication access, to improve understanding and adherence.

CLINIC COORDINATOR December 2014 – March 2017

Northeast Wisconsin Retina Associates

●Managed scheduling for all clinic locations and multiple physicians, optimizing provider availability, patient flow, and operational efficiency.

●Coordinated all aspects of surgical planning, including communication between physicians, hospitals, and clinic staff, as well as preparing surgical orders and preoperative instructions.

●Verified insurance eligibility and benefits, secured referrals and prior authorizations, and ensured all documentation met payer requirements.

●Identified non-covered services, obtained Advance Beneficiary Notices (ABNs), and proactively communicated financial responsibilities to patients.

●Assisted with patient billing and collections, including financial assistance applications, and served as a liaison between front office and business office teams to streamline communication.

●Supervised and supported medical administrative assistants, delegating responsibilities and ensuring smooth day-to-day clinic operations.

●Recognized for organizational leadership and cross-department coordination, helping implement scheduling and documentation practices that improved clinic efficiency and staff collaboration.

MEDICAL ADMINISTRATIVE ASSISTANT October 2012 – December 2014

Northeast Wisconsin Retina Associates

●Entered and maintained accurate patient data in practice management and EMR systems, including insurance, demographic, and financial information.

●Verified insurance eligibility and benefits, obtained prior authorizations and referrals to support timely care and reimbursement.

●Identified non-covered services and secured Advance Beneficiary Notices (ABNs) from patients to ensure transparency and compliance.

●Scheduled appointments and surgeries, coordinated across multiple providers and clinic locations, and managed follow-up for missed visits and neonatal ICU patients.

●Collected payments and balances, supported patients with financial assistance applications, and helped reduce billing delays through proactive communication.

●Prepared patient charts and documentation, handled medical record requests, and ensured all administrative paperwork met HIPAA and organizational standards.

PROFESSIONAL DEVELOPMENT

JCAHPO Certified Ophthalmic Assistant Oct 2022

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