Patient Access & Pre-Certification Specialist
Resume:
Atlanta, GA
************@*****.***
Alfonze Pratt
EDUCATION
Kent State University
OBJECTIVE
Results-driven Patient Access professional with extensive experience in hospital registration, insurance verification, and patient flow coordination. Demonstrated ability to support efficient Emergency Department and inpatient throughput by ensuring accurate patient account creation, real-time system updates, and seamless coordination between Cerner and STAR platforms. Strong background in revenue cycle processes, including eligibility verification, pre-certification, and account resolution to prevent delays in care and reimbursement. Recognized for delivering high-quality patient care, maintaining compliance, and collaborating across departments to improve operational efficiency and patient outcomes.
SKILLS
Patient Registration & Admissions
Insurance Verification & Eligibility
EXPERIENCE
Pre-Authorization/ Pre-Certification
Patient Estimates
Scheduling & Patient Intake
End to End Revenue Cycle Processes
Claims Review & Denial Prevention
ICD-9/ CPT Coding Knowledge
Attention to Detail & Accuracy
Communication & Team Collaboration
January 2014 - present
Patient Access Representative • Northside Hospital
Performed patient registration, insurance verification, and demographic data entry with a high level of accuracy in a fast-paced hospital environment.
Coordinated patient flow and supported bed placement processes to ensure efficient throughput from the Emergency Department to inpatient units.
Utilized Cerner and STAR systems to monitor patient status, update accounts, and maintain accurate tracking across systems.
Collaborated with clinical staff, nursing, and ancillary departments to facilitate timely admissions, transfers, and discharges.
Verified insurance eligibility and benefits, ensuring proper documentation for billing and reimbursement.
Identified and resolved account discrepancies to prevent delays in patient care and revenue cycle processing.
Provided excellent customer service by assisting patients and families with registration, questions, and navigation of hospital services.
Maintained compliance with HIPAA regulations and hospital policies while handling sensitive patient information.
September 2008 – December 2013
Atlanta Gastroenterology Associates • Pre-certification Specialist
Coordinate $6m Remicade account, four Infusion Center, clinical staff and daily operations.
Liaison between the doctor and pharmaceutical company.
Obtaining Precertification for all diagnostic procedures using ICD-9 and CPT codes.
Handle A/R accounts and reimbursements of all medical claims.
Medical Insurance / Healthcare Industry language.
Ability to accurately read and interpret EOB’s.
Knowledge of UB-92 and HCFA 1500, ICD-9.
Ability to accurately review and correct claims
January 2004– December 2007
Emory Neurosurgery Clinic • Revenue Cycle Specialist
Managed end-to-end revenue cycle processes including patient registration, insurance verification, and pre-certification for neurosurgical services.
Verified eligibility and benefits for HMO, PPO, POS, Medicare, and commercial insurance plans to ensure accurate billing and reimbursement.
Coordinated scheduling and authorizations for complex procedures, ensuring compliance with payer requirements.
Reviewed and validated patient accounts for accuracy, minimizing claim denials and delays in reimbursement.
Collaborated with clinical staff and leadership to support efficient patient flow and continuity of care.
Maintained detailed documentation and ensured compliance with HIPAA and organizational policies.
Provided administrative and operational support to enhance clinic efficiency and patient experience.
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