Prior Authorization & RCM Specialist
Resume:
Dorothy Lewis
214-***-**** • ***************@*****.***
Professional Summary
Experienced Prior Authorization and Revenue Cycle Specialist with deep expertise in Medicare, Medicaid, and commercial insurance processes. Proven track record in managing high-volume authorizations, reducing denials, and supporting complex specialties including behavioral health and neurosurgery. Strong background in medical coding, payer compliance, and patient financial counseling. Adept at collaborating with clinical teams, improving workflow efficiency, and ensuring timely reimbursement.
Core Skills
● Prior Authorization (Inpatient & Outpatient)
● Medicare, Medicaid & Commercial Insurance
● Denials & Appeals Management
● Revenue Cycle Management (RCM)
● Medical Coding (Certified)
● Eligibility & Benefits Verification
● Behavioral Health & Neurosurgery Authorizations
● Epic (Registration, Eligibility, Work Queues)
● Patient Financial Counseling & Collections
● Compliance & Payer Guidelines
● Staff Training & Mentorship
1
Dorothy Lewis
214-***-**** • ***************@*****.***
Professional Experience
Lifepath Systems
Insurance Specialist II May 2019 – Nov 2024
● Verified eligibility and benefits for Medicaid, Medicare, and commercial insurance plans
● Processed high-volume prior authorizations for inpatient substance abuse and mental health services
● Coordinated with providers and payers to ensure timely approvals and continuity of care
● Reduced authorization delays through accurate documentation and proactive follow-up
● Trained and mentored new employees, improving onboarding efficiency and team productivity
UT Southwestern Neurosurgery Department – Dallas, TX Financial Counselor / Clinic Liaison Sept 2015 – Jan 2019
● Managed prior authorizations for complex neurosurgical procedures across multiple facilities
● Utilized Epic for patient registration, eligibility verification, and benefits analysis
● Provided financial counseling, collected pre-service payments, and established payment plans
● Coordinated TriWest authorizations for veteran patients
● Assisted clinical teams with scheduling, coding support, and patient workflow
● Managed appeals and denials with commercial payers to improve reimbursement outcomes
2
Dorothy Lewis
214-***-**** • ***************@*****.***
Neurosurgery Reimbursement Specialist Sept 2010 – Sept 2015
● Maintained authorizations and ensured compliance with payer requirements
● Performed medical coding for five neurosurgeons, ensuring accuracy and compliance
● Managed Epic work queues including claims edits, backend processing, and authorizations
● Led appeals process for denied claims, increasing successful reimbursement rates
● Developed departmental billing policies and procedures Billing Coordinator Sept 2008 – Sept 2010
● Obtained authorizations for surgical procedures
● Collected pre-surgical deposits and supported front-end revenue cycle operations UT Southwestern Neurosurgery Department
Independent Contractor May 2006 – Sept 2008
● Secured prior authorizations and supported surgical financial workflows
● Assisted with patient payment collections and insurance coordination Blue Cross Blue Shield of Texas – Richardson, TX
Medical Underwriter Aug 2001 – May 2006
● Developed and implemented insurance policies for major corporate clients
● Applied underwriting guidelines to assess risk and coverage eligibility 3
Dorothy Lewis
214-***-**** • ***************@*****.***
Fortis Insurance – Richardson, TX
Senior Claims Analyst May 1994 – Aug 2001
● Processed medical, dental, and disability claims with high accuracy
● Ensured compliance with policy guidelines and reimbursement standards Customer Service Representative Nov 1992 – May 1994
● Assisted members with coverage inquiries, enrollment, and claim adjustments Key Achievements
● Successfully managed high-volume prior authorization workflows across behavioral health and neurosurgery
● Improved authorization turnaround times through proactive payer communication
● Increased reimbursement success by effectively managing appeals and denials
● Recognized for training and mentoring new team members
● Extensive cross-functional experience across payer and provider sides of healthcare Certifications
● Certified Medical Coder – Practice Management Institute Education
● Associate Degree in Paralegal Studies – Dallas Paralegal Institute
● Blinn College – General Studies
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Dorothy Lewis
214-***-**** • ***************@*****.***
Additional Strengths
● Strong knowledge of insurance policies, procedures, and compliance regulations
● Expertise in interpreting payer guidelines and navigating complex cases
● Excellent communication and collaboration with clinical and administrative teams 5
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