Remote Prior Authorization Specialist or Service Administrator
Resume:
Tawanna Thompson
Pensacola, FL *****
***************@*****.***
Professional Summary
Experienced healthcare administration professional with nearly 16 years in medical billing, insurance appeals, and customer service. Proven expertise in regulatory compliance, CRM systems, and remote support. Seeking a remote Prior Authorization Specialist or Service Administrator role to leverage strong communication, account management, and problem-solving skills for [desired company or industry]. Authorized to work in the US for any employer
Work Experience
Department of Defense Prior Authorization Representative Cigna Healthcare
October 2022 to February 2026
* Processed prior authorizations for medication for Tricare and commercial insurance members
* Demonstrated strong customer service skills while handling large volumes of calls
* Organized and sorted prior authorization requests for system processing
* Received and processed faxed prior authorization requests for timely decisions
* Reviewed and processed cost reviews, home infusion therapy forms, and quantity reviews
* Maintained HIPAA compliance and Department of Defense clearance General Manager
Fastest Labs
April 2021 to September 2023
* Managed office administration and onboarding processes for new employees
* Assisted owner with employee credentialing and compliance documentation
* Collected DNA samples and body fluids for testing and third-party analysis
* Conducted drug and breath alcohol testing for DOT and non-DOT requirements
* Set up agreements between companies and provided travel DNA collection services Home Health Aide
Sonshine Companion Care
February 2014 to April 2023
* Assisted family members by teaching safe patient lifting, turning, and repositioning techniques
* Cared for patients by changing bed linens, washing laundry, and supporting personal hygiene
* Maintained accurate and detailed records of patient care for supervisory review
* Monitored patient condition by documenting vital signs, physical and mental status, and nutrition
* Planned, purchased, prepared, and served meals according to prescribed diets
* Provided emotional support and instruction to patients and families for independent living
* Supported patients with mobility, dressing, grooming, and encouraged self-care
* Entertained and engaged patients to promote mental and emotional stimulation Field Support Specialist
Maxim Healthcare Staffing
July 2018 to July 2021
* Completed onboarding and hiring process for nurses, including background checks and payroll
* Answered phones, transferred calls, and maintained communication with nurse staff
* Credentialed staff and sent out patient referrals via email, mail, or fax
* Hosted meetings, shipped and received packages, and organized client and employee records Medical Secretary - Extern
Gulfcoast Pain Institute-Pensacola, FL
February 2018 to March 2018
* Answered telephones and directed calls to appropriate staff
* Compiled and recorded medical charts, reports, and correspondence
* Greeted visitors and directed them to appropriate staff
* Interviewed patients to complete intake and insurance forms
* Maintained medical records and correspondence files
* Performed clerical functions and managed inventory of supplies
* Scheduled and confirmed patient appointments and transmitted records by mail, email, or fax Teacher Aide/Assistant
Escambia County School District
February 2013 to January 2018
* Enforced administration policies and rules governing students
* Instructed and monitored students in safe use of equipment and materials
* Observed and documented student performance
* Provided extra assistance to students with special needs, including non-English speakers and those with disabilities
Education
Psychology (Diploma)
Peach Academy
September 2024 to September 2024
Medical Billing & Coding (Diploma)
Expert Skills
September 2024 to September 2024
ESL Education (Diploma)
Expert Skills
August 2024 to August 2024
Medical Office Administration (Diploma)
Fortis Institute-Pensacola, FL
2017 to 2018
Medical Office Administration (Associates in Medical Office Administration) Fortis Institute
Upper secondary education
Healthcare Management (Associate of Science)
Ultimate Medical Academy
Diploma
Expert Skills
Diploma
Fortis Institute
Some college
High school diploma or GED
Diploma
Expert Skills
Associate of Science
Ultimate Medical Academy
Diploma
Peach Academy
Some college
Medical Office Administration (Associates in Medical Office Administration) Fortis Institute
Diploma
Expert Skills
Skills
Talent career development Practice Structure Medicare EMR systems Conducting sales calls Business Office Operations Microsoft Teams Fundraiser event planning Supervising experience Medical billing payment report preparation Pharmaceutical regulatory compliance Record keeping Microsoft Word Care plans Research Clinical documentation Home visits (communication methods) Payroll Mac OS Negotiation Regulatory compliance Patient interaction Client services ICD-9 Customer communication Appeals Microsoft Excel Human resources Managing customer accounts Computer operation Team motivation (leadership skill) Self- directed learning Personal assistant experience English Home health Search engines Centers for Medicare and Medicaid Services (CMS) Medical Scheduling Health insurance claim processing Training & development Skype Insurance prior authorization DOT (Department of Transportation) regulations FMLA Phone etiquette NCQA standards Inpatient Adobe Acrobat Adhering to traffic regulations Healthcare Law Phone communication Accounting Conflict management Computer literacy Databases Mental health and behavioral care Cash handling Level I Trauma Center Cooking Medical credentialing Laboratory experience Medical collection Electronic health records (EHR) management Typing Debt collection negotiation ICD-10 Customer support Insurance Billing Procedures CMS1500 Customer relationship building Managed care Clear language communication Filing Organizational Improvements Paratransit Customer support experience within finance industry Client communication AI ICD coding Anatomy & Physiology Medical insurance appeals management Hospitality Data management Data analysis skills Epic Human Resource Management Customer complaint resolution Medical office experience Schedule management Data entry Achieving HIPAA compliance Time management Working with people with developmental disabilities Surgery Microsoft Powerpoint Medication administration Team management Remote technical support Charitable promotional events Patient collections management Aging report preparation Organizational skills Communication skills Guest services Group home Sales Windows Interpersonal Professional Communications CRM system proficiency Attention to detail Microsoft Outlook Records management Medical Practice Management Systems Hotel experience Healthcare Management Adolescents Technical Proficiency Payment posting in medical billing systems UB04 Appointment scheduling Banking Systems Charting Term negotiation Revenue cycle management Medical billing productivity report preparation Order processing Special Needs Administrative experience Cross- functional communication Pharmacies (work setting) Healthcare Claim Cycle Account management Settlement negotiation Customer service Equipment troubleshooting Regulatory compliance in claims processing Analysis skills Contracts Medical terminology Data collection Accounts receivable Sensors Insurance Verification Customer expectation management Inside sales Documentation review Blood sampling Medical Office Procedures Leadership & Management Processing Co- Payments CMS1450 Home Care System testing State-specific medical credentialing regulations HIPAA Compliance State healthcare regulations OSHA Interpersonal skills HIPAA Customer inquiry handling Customer support experience within technology industry Calendar management Maintaining patient confidentiality Medical billing Insurance medical billing Collaborate with healthcare professionals Microsoft Office Cerner Medical claim denial management Productivity software Cash register Client interaction via phone calls Skilled nursing facility Task prioritization Employee relationship building Patient monitoring Live chat Insurance claim appeals processing
Languages
• English
Certifications and Licenses
ESL Certification
Present
Certified Remote Online Notary Public
August 2024 to Present
TWIC
August 2024 to Present
Home Health Aide
Medical License
BLS Certification
Certified Coding Specialist
TESOL Certification
Medical Coding Certification
ServSafe
Driver's License
Certified Notary Public
CPR Certification
Certified Coding Associate
Non-CDL Class C
Passenger Endorsement
Medical Billing Certification
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