Hi, I’m
Shana Buzzell
Murfreesboro
Summary
Adept at streamlining prior authorization and benefits verification processes, I significantly enhanced efficiency at Feltz Therapy Services. My expertise in electronic health records and exceptional communication skills led to a notable increase in customer satisfaction and authorization success rates, demonstrating both hard and soft skills critical for high-stakes insurance and healthcare environments.
Overview
17
years of professional experience
Work History
Feltz Therapy Services
Prior Authorization Specialist
01.2019 - Current
Job overview
- Confirmed all requirements for authorization were met by service providers.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- 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.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Streamlined prior authorization processes by implementing efficient tracking systems.
- Collaborated with insurance companies to clarify coverage details and expedite review of complex cases.
- Enhanced efficiency in processing prior authorization requests by streamlining documentation procedures.
- Reduced turnaround time for prior authorization decisions by implementing more efficient review process.
- Supported healthcare providers by offering guidance on alternative treatment options when initial requests were denied.
Feltz Therapy Services
Benefits Verification Specialist
01.2019 - Current
Job overview
- Contributed to developing procedures for benefits verification, guaranteeing smooth implementation.
- Optimized the use of electronic claims submission systems to expedite claim processing times.
- Increased customer satisfaction by effectively addressing intricate benefits concerns.
- Ensured timely reimbursements by proactively identifying potential issues that could delay claim processing and addressing them before submission.
Wedgewood Healthcare Center
Admissions Coordinator
09.2007 - 05.2014
Job overview
- Confirmed all insurance benefits met standards of admissions as dictated by policy.
- Assisted in patient admission process based on federal and state laws.
- Collaborated with admissions team to develop and implement strategies to improve admissions process.
- Compiled and analyzed data to track admissions trends and make recommendations for improvements.
- Completed preliminary paperwork for incoming and outgoing patients.
Education
Bonny Eagle High School Standish, ME
High School Diploma from General Studies And Business Prep
06.1993
Skills
- Prior authorization process
- Medical terminology
- Insurance verification
- Effective communication skills
- Data entry
- Electronic health records proficiency
- Benefit coverage
- Professionalism and ethics
- Insurance procedures
- Retro-authorizations
- Patient confidentiality compliance
- Private insurance
- Eligibility determination
- Multitasking
- Telephone etiquette
- Documentation and paperwork
- Teamwork
- Customer service
- Attention to detail
- Problem-solving abilities
- Multitasking ability
- Reliability
- Excellent communication
- Organizational skills
- Computer proficiency
- Task prioritization
- Teamwork and collaboration
Timeline
Prior Authorization Specialist
Feltz Therapy Services
01.2019 - Current
Benefits Verification Specialist
Feltz Therapy Services
01.2019 - Current
Admissions Coordinator
Wedgewood Healthcare Center
09.2007 - 05.2014
Bonny Eagle High School
High School Diploma from General Studies And Business Prep
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