Sarah Robinson
Westmoreland
Summary
Experienced with navigating healthcare insurance systems to secure treatment approvals. Utilizes keen attention to detail and extensive knowledge of medical coding to streamline processes. Strong understanding of insurance guidelines and patient advocacy to ensure optimal outcomes.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Macon Community Hospital
04.2024 - Current
- Reviewed and processed prior authorization requests for accuracy and compliance with healthcare regulations.
- Collaborated with healthcare providers to gather necessary documentation for authorization approvals.
- Utilized electronic health record systems to track and manage patient information efficiently.
- Communicated with insurance companies to clarify coverage details and resolve authorization issues.
- Ensured timely follow-up on pending authorizations to optimize patient care delivery timelines.
- Trained new team members on procedures for processing prior authorization requests accurately.
- Developed streamlined workflows that enhanced efficiency in the authorization process across departments.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
Customer Service Representative
Security Finance, Financial Services
10.2023 - 04.2024
- Assisted customers with inquiries, ensuring timely resolution and high satisfaction levels.
- Processed loan applications accurately, adhering to compliance guidelines and internal policies.
- Maintained customer records in CRM system, enhancing data integrity and accessibility for service teams.
- Trained new representatives on company procedures, promoting a culture of knowledge sharing and efficiency.
Mikes Foodland
Mike Williams
05.2022 - 10.2023
- Self-motivated, with a strong sense of personal responsibility.
- Addressed customer inquiries and resolved issues promptly, enhancing shopping experience satisfaction.
- Developed staff schedules to ensure optimal coverage during peak business hours, improving operational efficiency.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Worked well in a team setting, providing support and guidance.
- Demonstrated respect, friendliness, and willingness to help wherever needed.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Oversaw daily grocery operations, ensuring compliance with safety and health regulations.
- Managed inventory levels, optimizing stock availability and reducing waste through strategic ordering.
- Trained and mentored team members on best practices for customer service and product knowledge.
Education
High School Diploma -
Red Boiling Springs High School
Red Boiling Springs, TNSkills
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Authorizations
- Insurance verification
- Effective communication skills
- Medical terminology knowledge
- Retro-authorizations
- Records maintenance
- Provider relations
- HIPAA compliance
- ICD-10 coding
- CPT coding
- Precertification requirements
- Telephone etiquette
Certification
- BLS AND CPI Training - [Timeframe]
Timeline
Prior Authorization Specialist
Macon Community Hospital
04.2024 - Current
Customer Service Representative
Security Finance, Financial Services
10.2023 - 04.2024
Mikes Foodland
Mike Williams
05.2022 - 10.2023
High School Diploma -
Red Boiling Springs High School