Prior Authorization Office Coordinator

Tonjau Wyatt

************@******.*** 713-***-**** Houston, TX

SUMMARY

Seeking role as Patient Access Specialist - Prior Authorization with 12 years of experience in healthcare administration. Expertise in insurance eligibility, medical necessity, and prior authorization processes, honed through roles such as UM Precert Coordinator and Claims Analyst. Proven ability to enhance operational efficiency and resolve complex issues within healthcare settings.

WORK EXPERIENCE

CCD Strategic Solutions

Office Coordinator Nov 2021 - Present

• Coordinate daily operations to ensure alignment with company policies and procedures.

• Facilitate communication to the management team and staff regarding healthcare benefits and oversee the selection process for firm-wide healthcare plans.

• Manage incoming calls, meeting requests, event coordination, and travel arrangements for the CEO and management team.

Community Health Choice

UM Precert Coordinator Nov 2020 - Aug 2021

• Obtained and processed essential information to secure precertifications and authorizations from payors.

• Managed incoming communications effectively, enhancing daily productivity within the precertification department.

• Resolved complex departmental issues, contributing to improved operational efficiency. WellCare

Network Relations Consultant Mar 2020 - Aug 2020

• Cultivated and sustained strong relationships with healthcare providers through consistent on-site visits and effective communication of administrative updates.

• Facilitated the resolution of provider issues by delivering education and support on programmatic changes. Anthem

Utilization Manager – Non-Clinical Nov 2013 - Aug 2018

• Fostered professional development and growth among nonclinical staff to enhance support for member and provider needs.

• Assisted in formulating strategies aimed at increasing profitability through expansion of referral sources and organic marketing initiatives.

• Cultivated strong community relationships to bolster organizational presence and engagement. Amerigroup

Claims Analyst Apr 2012 - Oct 2013

• Analyzed medical insurance claims to verify eligibility and accuracy, directly impacting reimbursement outcomes.

• Conducted investigative research and prepared documentation, performing risk analysis to ensure compliance with policies and regulations.

Sr. Care Specialist Team Lead Jun 2010 - Mar 2012

• Coordinated and monitored daily work assignments, assisting in the establishment of effective work schedules.

• Ensured staff compliance with procedures, protocols, and standards while evaluating work for quality and efficiency.

EDUCATION

Mary Brantley Smiley High School

High School Diploma

SKILLS

Detailed Oriented • MS Office Proficiency • Professional Telephone Demeanor • Creative Problem Solving • Complaint Resolution • Organized • Rapport and Relationship Building • Epic • Citrix • Jiva • QNXT • Staff Education and Training • Contract Negotiation • Facets • Medical Terminology Knowledge • Sap • Communication

• Documentation • Problem-solving • Attention To Detail • Collaboration

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