Insurance Authorization Specialist with Quick Adaptability
Resume:
Samantha Hylton
Cynthiana, KY *****
*************@*****.***
Professional Summary
Firstly, I want to say thank you for taking the time to look over my Resume. I’m a very goal oriented person and I may not have the exact college degree or the exact experience that the job requires BUT I do have experience in a lot of other fields and I learn new things very quickly. I adapt to any and all situations. I'm a quick thinker and a good problem solver. I believe I would be perfect for the position offered. If given the chance you won't be disappointed. Please feel free to contact me through my email/ phone any time of the day if you need any more information. Thanks so much. Authorized to work in the US for any employer
Work Experience
Insurance Authorization Specialist
Kenney Orthopedics-Cynthiana, KY
November 2022 to Present
• Reviewed and processed pre-authorization requests for medical procedures, ensuring compliance with insurance guidelines
• Verified patient eligibility and benefits coverage to determine if pre-authorization was required
• Collaborated with healthcare providers to obtain necessary documentation and clinical information for pre-authorization requests
• Maintained accurate records of all pre-authorization activities in the electronic database
• Communicated with insurance companies to follow up on pending or denied pre-authorization requests
• Resolved issues related to incomplete or inaccurate documentation by coordinating with healthcare providers and insurance companies
• Developed strong knowledge of different insurance plans, policies, and procedures related to pre- authorizations
• Ensured timely submission of complete and accurate pre-authorization requests to minimize delays in patient care
• Managed a high volume of incoming calls from patients, healthcare providers, and insurance representatives regarding pre-authorizations
• Collaborated with the billing department to ensure proper coding and billing practices for authorized procedures
• Identified opportunities for process improvement in the pre-authorization workflow and implemented effective solutions
• Provided training and guidance to new team members on the processes involved in handling pre- authorizations
• Maintained confidentiality of patient information according to HIPAA regulations at all times Insurance Verification Clerk
Lexington Surgery Center-Lexington, KY
February 2019 to November 2022
1. Provides services in a timely and cost effective manner 2. Confirm that all benefits for patients are active and current 3. Obtain authorizations through insurance companies. 4. Verify that the authorization that was obtained is correct and up to date. 5. Provide cost information to patients and families. 6. Adheres to all hippa rules
7. Reports to Office Manager
8. Completes all tasks given by office manager.
Medical Records Technician
Lexington Surgery Center-Lexington, KY
2019 to November 2022
1. Complete any and all medical records requests from outside the surgery center 2. Break down, check, log, and verify all patient charts 3. Scan all documents into our secure dox system according to patient. Department Assistant
Shriners Hospitals for Children-Lexington, KY
December 2018 to 2019
I answer voicemails and take calls for patients
Checkout all patients scheduled for the day
Complete all tasks from the providers, care managers, and my manager Help with sign in and registration
Work with the Drs to make sure the patients will be seen in a timely manner And pretty much anything else that the clinic staff needs Technician
HIM-Lexington, KY
January 2014 to 2018
Complete task's delegated to me by Dr.'s and my boss. Send and log all notes to outside physicians. Scan all documents into patient charts, check said documents to make sure their destination was correct. Ability to work quickly and efficiently in a fast paced environment. Ability to prioritize as well as multi- task. Vast knowledge of all Microsoft programs plus more computer programs that relate specifically to my current position. (Current Full Time Position)
SRNA
The Jordan Center-Louisa, KY
January 2013 to October 2014
Take Accurate vital signs, report to charge nurse, provide accurate care for my residents, document any and all actions done in a 12- hour period. Ability to care for my residents on a physical and emotional lever, able to quickly and discreetly resolve any conflict, work well with others verbal and written communication, multitasking. People skilled, taking charge in difficult situations, observing my documentation on the computer and in my headset.
Education
High School Diploma
Lawrence County High School
2002 to 2006
Some college
Skills
• Excellent computer skills
• Microsoft Word
• Grammar Experience
• SCANNING
• State healthcare regulations
• Medicare
• Microsoft Windows Server
• Regulatory compliance
• EXCELLENT COMMUNICATION SKILLS
• Electronic health records (EHR) management
• Zoom
• VMWare
• Microsoft Access
• Microsoft SharePoint
• PROBLEM SOLVER
• Basic math
• Insurance verification
• Organizational skills
• Medical office experience
• Front desk
• OUTLOOK
• Maintaining patient confidentiality
• Leadership
• All Microsoft Programs
• VPN
• Office experience
• Phone etiquette
• Computer Networking
• Customer service
• Medical terminology
• Microsoft Outlook
• Attention to detail
• Google Docs
• Nymbl system
• Health information management
• ICD coding
• Operating Systems
• English
• ICD-10
• LAN
• EMR systems
• Proofreading
• Typing
• Insurance prior authorization
• Microsoft Powerpoint
• Microsoft Excel
• Writing skills
• Microsoft Windows
• HCPCS
• Sales
• Outpatient
• Epic
• Active Directory
• Word processing
• Microsoft Exchange
• Health insurance authorizations
• Microsoft Office
• CPT coding
• EHR systems
• Records management
• Appointment scheduling
• Intake
• CITRIX
• Windows
• HIPAA
• Time management
• ICD-9
Languages
• English
Certifications and Licenses
CNA
Driver's License
Additional Information
Skills:
All Microsoft Programs, Outlook, 1080 Data Base, Citrix Receiver, Scanning Programs, Explorer, Can type 50+ words a minute, Excellent communication skills, Very well organized, Ability to multi-task and prioritize, People skilled, Quickly learns new abilities, Adapts to all situations, Ability to resolve conflict discreetly.
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