Skylah Jennings
Prior Authorization Coordinator
Crossville
Summary
Highly-motivated Prior Authorization Coordinater with a strong worth ethic and desire to take on new challenges. Adept at working effectively in fast paced environments unsupervised, quickly mastering new skills, strong attention to detail, and upbeat mentality. Skilled in supporting patient medical needs by customer service proficiency, attending to medical needs, and assisting in researching and providing financial recourses. Paired with previous experience in online retail operations, which consists of document and data entry, financial tracking, and inventory management.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Prior Authorization Coordinator
Neurology Care
Ardmore
03.2024 - Current
- Processed prior authorization requests for neurology services efficiently.
- Reviewed patient charts to ensure completeness and accuracy of information.
- Coordinated with insurance companies to verify coverage and benefits.
- Maintained detailed records of authorization requests and outcomes in system.
- Assisted patients in understanding their insurance coverage and requirements.
- Trained new team members on prior authorization procedures and protocols.
- Notified ordering providers of denied authorizations.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Coordinated resolutions for issues and appealed denied authorizations.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Communicated with healthcare providers to clarify patient information and documentation.
Reviewed prior authorization requests for medical services and treatments. - Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers. - Notified ordering providers of denied authorizations.
Provided guidance to providers regarding the prior authorization process. - Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Developed relationships with external vendors providing pre-authorization services.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Assisted with medication financial assistance process when necessary.
- Determined medical necessity of medical devices such as VNS & Inspire device by reviewing patient records and corresponding with providers as needed.
- Corresponded with Drug & Medical Device Reps to schedule lunches and meetings with providers.
- Organized lunch calendar and orchestrated and ordered catered meals for office staff.
- Maintained scheduling of collaborative appointments with medical device representatives and providers.
- Analyzed denied claims in order to identify potential issues that could be addressed proactively.
- Processed high volume of requests within established turnaround times while maintaining quality standards.
- Maintained up-to-date knowledge of healthcare reimbursement policies, regulations, and industry trends.
- Created and maintained accurate documentation for all prior authorization activities.
- Identified discrepancies in submitted documents or coding errors that may affect payment or reimbursement.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients.
- Monitored changes in insurance policies and guidelines to ensure compliance with prior authorization processes.
- Conducted regular audits of medication samples inventory.
- Coordinated with pharmacy staff to ensure medications requiring prior authorization are processed correctly.
- Assisted in the development of educational materials for patients about the prior authorization process and insurance benefits.
- Negotiated with drug manufacturers and insurance providers to obtain coverage for off-label or non-formulary medications.
- Followed up on pending prior authorization requests to ensure timely processing.
- Educated healthcare providers on prior authorization requirements and insurance formulary changes.
- Utilized medical coding knowledge to accurately process and document authorization requests.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Ordered and maintained medication sample supply inventory for medical office.
- Arranged hospital admissions for patients as required.
- Interviewed patients to complete case histories and medical questionnaires.
- Transcribed recorded practitioners' diagnoses and recommendations into medical records.
- Reviewed and processed prior authorization requests according to insurance guidelines.
- Collaborated with healthcare professionals to verify prescription accuracy.
- Educated patients on medication administration and potential side effects.
- Educated patients about their medications, potential side effects, proper storage instructions.
- Organized and tracked all orders for Medication Samples and Buy & Bill medications such as Botox.
- Entered prescription information into computer databases.
- Received written prescription or refill requests, verifying information for completeness and accuracy.
- Received written prescriptions and refill requests from patients, evaluating information for completeness and accuracy before filling.
- Ordered, labeled and counted stock of medication samples and entered inventory data into computer.
- Answered questions regarding personal medications or over-the-counter pharmacy products.
- Documented patient side effects and responses to medications and infusions in electronic health records.
- Communicated effectively with patients to address concerns and provide support.
- Managed multiple tasks simultaneously while maintaining attention to detail.
- Provided patient education on the use of IV therapy and potential side effects.
- Evaluated patient response to treatments and adjusted medication dosages accordingly.
- Assisted in the preparation of sterile supplies and injection equipment.
- Spoke with patients to better understand experienced side effects, noting details in charts for physician follow-up.
- Prepared medical equipment and tools to aid physician during examination and treatment of patients.
- Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
Checkout Operator
Neurology Care
Ardmore
03.2024 - 06.2024
- Pleasantly welcomed patients to check out desk and engaged in friendly conversations while conducting check-out process.
- Scheduled and coordinated patient appointments and EMG & EEG procedures over phone and in person, maximizing productivity.
- Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
- Retrieved faxes and uploaded documents to patient charts to assist clinical staff.
- Carried out daily tasks by professionally communicating with physicians, nursing staff, technicians and medical assistants.
- Faxed referrals for MRI's, Sleep Studies, and other procedures and specialist care when requested by physicians or patients.
- Collected patient information and maintained accurate medical records securely.
- Provided support to clinical staff during patient visits, including rooming patients, collecting vital signs and documenting chief complaints.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Assisted in patient education regarding medical procedures and pre-visit requirements.
- Scheduled tests, lab work or x-rays for patients based on physician orders.
- Communicated effectively with team members to ensure smooth operation of checkout lanes.
- Learned roles of other departments to provide coverage and keep clinic operational.
- Processed cash, credit, debit, and check payments accurately and efficiently.
- Assisted in training new staff on scheduling software procedures.
- Provided feedback on areas needing improvement within office operations in order to increase efficiency.
- Assisted patients with canceling and rescheduling appointments.
- Tracked and reported on appointment no-shows and cancellations, analyzing trends for management.
- Communicated with healthcare providers to clarify patient information and documentation.
- Reviewed prior authorization requests for medical services and treatments.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Notified ordering providers of denied authorizations.
- Provided guidance to providers regarding the prior authorization process.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Developed relationships with external vendors providing pre-authorization services.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
Patient Appointment Coordinator (Secretary)
Dean McGee Eye Institute
Oklahoma City
09.2023 - 03.2024
- Communicated with patients with compassion and helped patients and families feel comfortable during challenging and stressful situations, promoting reduced compliance issues.
- Documented and responded to incoming correspondences such as answering telephone inquiries to address questions from patients regarding appointment scheduling, office policies, and medications.
- Answered patients questions about their conditions and medications prescribed based upon their physician's chart notes.
- Counseled patients on appropriate use of over-the-counter and prescription medications.
- Routed calls and correspondence to appropriate medical staff or administrative staff.
- Registered and verified patient demographic information and insurance coverage for accuracy in electronic health records systems including Epic, Group Management, Ifa, and Phressia.
- Utilized knowledge of medical terminology to accurately assist patients with scheduling, canceling, and rescheduling appointments for various services, medical tests, procedures, and specialists.
- Evaluated medical insurance details and informed patients of uncovered fees.
- Coordinated referrals between primary care physicians and specialists as required.
- Conducted follow up calls to confirm scheduled appointments and followed up with no-shows or late arrivals to reschedule missed appointments.
- Managed physician's calendar and organized schedule of all upcoming appointments, cancellations, and waitlists.
- Resolved complex scheduling conflicts within a physician's schedule and between multiple providers and specialties.
- Collaborated with other departments in the organization to ensure smooth functioning of operations.
- Transcribed doctor's orders into the electronic health record system.
- Prepared letters, reports, or memos on behalf of the office staff.
- Transmitted medical records and other correspondence by mail, e-mail, or fax and assisted with other administrative tasks as needed such as filing and data entry.
- Prepared and constructed detailed reports related to pre-authorizations, appeals, and denials such as medical records of diagnoses and treatments.
- Developed strategies aimed at improving efficiency within the prior authorization process including gathering information to file appeals for medication denials and minimized inaccuracies by maintaining accurate records of approvals.
- Advised patients on the status of their appeals and any follow-up actions required.
- Provided guidance and support to coworkers on prior authorization processes.
- Guided coworkers in handling difficult or complex problems and assisted on appointment scheduling procedures.
Patient Service Representative (Front Desk)
Dean McGee Eye Institute
Oklahoma City
11.2022 - 09.2023
- Pleasantly welcomed visitors to front desk and engaged in friendly conversations while conducting check-in process and directed patient to appropriate location or person.
- Answered phone calls, organized files, and maintained front desk and reception area in neat and organized fashion.
- Provided helpful assistance by anticipating and responding to needs of patients and family members while maintaining and handling high volume clinics.
- Registered and checked-in patients by verifying records to update computer system and patient charts.
- Accessed patient information through multitasking various software applications, such as Group Management, Ifa, and Phreesia, while upholding strict confidentiality to remain compliant with HIPAA regulations.
- Scanned completed forms, referrals, identification and insurance cards, preserving patient documents folder.
- Verified and updated patients' insurance and copay information.
- Accepted, processed, and applied patient's payment toward account balances in person and over the phone; along with providing receipts and proper bills or change during check-in and check-out processes.
- Scheduled patient appointments and procedures over phone and in person, maximizing productivity.
- Maintained updated knowledge through continuing advanced training.
- Worked successfully with diverse group of coworkers to accomplish goals and services.
Online Reseller
Ebay Enterprise
Oklahoma City
05.2022 - 09.2023
- Maintained high feedback ratings from customers by responding quickly to questions and problems.
- Followed up with customer inquiries promptly and maximized internet lead opportunities.
- Built and maintained knowledge of products and current sales pricing.
- Cultivated strategic customer relationships, evaluated needs and opportunities within customer accounts and negotiated to gain sales commitments.
- Resolved customer concerns and answered questions quickly to maximize satisfaction.
- Composed descriptions of merchandise for posting to online storefronts.
- Filled customer orders by packaging sold items and documentation for direct shipping and by transferring orders to manufacturers or third-party distributors.
- Created, managed, and automated orders and invoices using order management and invoicing software.
- Handled all aspects of business, including accounting, purchasing, and photography for products.
- Used Excel spreadsheets to track inventory, track business expenses, and make forward-thinking business plans.
Education
Associate of Science - Psychology
Roane State Community College
Harriman, TN12.2021
Skills
- Prior Authorizations & Appeals
- Procedure & Infusion Referrals
- Management of Stock & Inventory
- Data Entry
- Insurance Verification
- Payment Collection
- Medical Databases- Epic, Group Management, Ifa, and Phressia
- Front Desk & Secretarial Operations
- Appointment Scheduling Coordination
- Microsoft Office Tools
- Leadership
- Problem Solving & Conflict Resolution
- Strong Work Ethic
- Effective Under Pressure
- Organized & Detail-Oriented
- Multitasking
Certification
- OSHA Training - 2019
Accomplishments
• Graduated high school early with distinction.
• Graduated college with the highest honor, Summa Cum Laude.
• Maintained a 3.8 GPA throughout college.
• Deans List for four consecutive semesters.
• Graduated college with the highest honor, Summa Cum Laude.
• Maintained a 3.8 GPA throughout college.
• Deans List for four consecutive semesters.
Timeline
Prior Authorization Coordinator
Neurology Care
03.2024 - Current
Checkout Operator
Neurology Care
03.2024 - 06.2024
Patient Appointment Coordinator (Secretary)
Dean McGee Eye Institute
09.2023 - 03.2024
Patient Service Representative (Front Desk)
Dean McGee Eye Institute
11.2022 - 09.2023
Online Reseller
Ebay Enterprise
05.2022 - 09.2023
Associate of Science - Psychology
Roane State Community College