Health Care Prior Authorization

Alaina Johnson

SUMMARY

Biologics Coordinator with 20+ years of customer service experience. Expertise in Verification, Prior Authorization, Payroll, Office Management, Interviewing, Training, Inventory and possesses strong communication and leadership skills.

SKILLS

Administrative

Counselling

Payroll

Staffing

Leadership

Office Management

Prior Authorization

Insurance Verification

Account Management

Auditing

Inventory

NPI registry

Credentaling

Support

Surgical Scheduling

Records Management

Database Administration

Medical Management

Medical supply control

Data Spreadsheets

Communication Skills

PROFESSIONAL EXPERIENCE

Aston Carter / Biologics Coordinator 04/2021 – Present

Organize medication dispersements.

Confirm electronic and fax enrolment.

Confirm insurance coverage.

Confirm medical procedures.

Confirm infusion and treatment centres.

Collect and confirm Physician NPI’s.

Input Health Plan / Pharmacy data.

Create care teams and treatment plans.

Refer foundation information per Health care provider.

Register patients into copay program.

Collect all documentation for Patient assistance program.

Interact with both commercial and government payors

Assist Patient / Health care provider per navigation with medication portal.

CNG Home Health Care Agency 01/2000 – 04/2020

Social Worker Liaison Consultant,

Payroll

Effective attending skills.

Passionate interaction abilities.

Essential processing and reformatting of life skills.

High tolerance per unstable conditions.

Establishing goals, targets, and assist progression.

Compassionate and understanding the needs of others.

Schedule appointments.

Verify appointments.

Verify insurance coverage.

Verify medical procedures.

Verify billing codes. (cpt / icd)

Assemble and collect labs.

Complete medical records. request

Request medical records.

Submit medical record request.

Check the number of hours worked.

Calculate wages, salaries, pay raises, shift changes, and overtime.

Collect all documentation to complete medical records per visit.

Issued checks via direct deposit or paper.

Maintained employee records.

Inputted / changed Banking information.

Benefit corrections.

CNG Home Health Care Agency 12/2005 – 12/2011

Surgical Coordinator/Medical Liaison

Completed preoperative paperwork.

Set surgery dates with patients within schedule.

Prepared information for patient

Ensured all preoperative testing is scheduled.

Performed comprehensive client assessments on an ongoing basis to ensure continuity of care.

Ensured timely and accurate communication and documentation is submitted to the appropriate payer source for continued authorization.

Elevated patient, family and/or significant other in the return to optimal physical and mental health through support and education. Supplied staffing needs per hospice care.

Counselled all staff. Monthly Scheduling per all staff patient ratio.

Maintained confidentiality of all agency and patient related information.

Protected patient rights as defined in the patient Bill of Rights. Organized workload to complete responsibilities in an appropriate and timely manner.

Performed other duties as assigned per Supervising Administrator.

CNG Home Health Care Agency 12/2010 – 12/2015

Staffing Coordinator/Insurance Verification

Responsible for planning, organizing, prioritizing and the scheduling of workers.

Confirmed and guaranteed that all employees comply with all state laws requirements and regulations.

Verified Insurance per medication needs.

Submitted per the denial/approval of Prior Authorizations.

Provided guidance to the field in processing corrections to errors.

Assisted Team Leader in monitoring tolerance levels to ensure their appropriateness.

Evaluated and made recommendations regarding coverage.

Conducted investigations, determined the total value of claims, sets and maintained adequate reserved and managed cases.

Remained current on trends and latest developments in the medical management field. Attends related training programs when required. Processed claims with CPT and ICD-10.

Evaluated processes and takes appropriate action on claim-related bills, medical rehabilitation and special investigative reports. Determines claims to be paid or contested.

Requested information from Providers.

Interfaced with customers, company sales and/or service representatives to handle a variety of pre-sales or post-sales service functions.

Verified multiple insurances, handles requests for additional company materials.

Maintained records of each sales order, schedule changes to product or changes, product pricing.

Corrected and resolved all problems pertaining to client’s order.

Prior Authorization process with insurance companies and practitioner offices.

Acted as a subject matter expert in completing a full Medical Verification for medications, administration of supplies and related pharmacy services.

Facilitated pharmacy and/or major medical claims with insurance companies and practitioner offices and investigates and facilitates prior authorization insurance rejections.

Placed outbound calls to patients or physicians’ offices to obtain additional information needed to process the script or to notify of delay in processing script.

Managed inbound calls on the Insurance line from patients, clients, physicians, practitioners, and clinics regarding inquiries about the services provided, financial responsibility and insurance coverage.

De-escalated complex issues related to patient coverage/responsibility for services.

CNG Home Health Care Agency 01/2000 – 12/2005

Accounts Payable/Receivable/Claims Coordinator II

Reviewed a high volume of transactions daily to ensure data is received and reconciled appropriately.

Researched and corrected errors, variances, and exceptions.

Communicates with team members and Field Consultants to resolve reporting problems or out-of-balance conditions.

Negotiated health care plan/coordinated benefits.

United States Navy, Aboard the USS Kittyhawk 09/1992 – 12/1998

Accounts Payable/Receivable Material Control/Auditor/Customer Service Production

Duties included, but not limited to the following: Controlled a Billion-dollar budget for all Military bases around the world with 24 turn-around time frames required daily report to CO and XO per Nasvab in a timely manner.

Data entry, Format Spreadsheets, Organization, Communication. VFA – 542 Air Line Hanger and or USS Kitty-Hawk or the USS Roosevelt.

Parts and or equipment needed for all Air-crafts and or all Aircraft Carriers. Billing, Raw Materials, Chemicals, and Weapon Control.

EDUCATION

Doctoral candidate psychology

Master of Arts Organizational Management, Ashford University

Bachelor of Liberal Arts, Ashford University

Associates Medical Management, United States Navy, NAS Miramar

Associates Business Administration, United States Navy, NAS Fallon

Computer Software:

Microsoft Suite, Pulse, File-Maker Pro, NAS Skill, Workforce, Brightree, Omni, Avility, Humana-Portal,

United Healthcare Portal, Wellcare-Portal, Compass, Windows Experience Mediation & Advocacy Programs

Contact this candidate