Authorization and Insurance Navigation Specialist - MedQuest Imaging - Winston-Salem, NC
(2022-10)
Utilized problem-solving skills to resolve complex navigation issues with confirmation of Authorizations in for ordered physician imaging. Guide patients through complex Insurances regarding benefits and authorization involving imaging requests for (MRI, CT, u/s, Nuclear Med, etc). Responsible for verification of patient eligibility, the pre-certification of services as required, ensuring coverages are updated, validating authorizations already on file, and providing price estimates upon request.
- Verify patient's insurance status and benefit eligibility.
- Accurately determine the patient un-met deductible, co-insurance, and co-payment amounts
- Accurately and timely provide for any pre-authorization or pre-certification of services.
- Communicate with center staff, referring offices, team members, leaders, and schedulers.
- Provide high level of customer service with goal of maintaining low cancellation and auth denial rates while increasing Time of Service collection rates.
- Meet or exceed established productivity standards.
- Meet or exceed established quality assurance standards and maintain customer experience expectations.
- Meet or exceed established error standards.
- Meet or exceed expectations related to phone and instant message response time and quality of service provided in those interactions.
- Ensure patients that are not approved or covered for services are notified timely and provided all options including rescheduling and waivers.
- Provide price estimates prior to scheduling when requested.
- Other duties as assigned.
Prior Authorization Specialist / Clinical Secretary - Novant Health Lakeside Primary Care - Afton - Afton, US
(2017-02 - 2022-10)
- Monitor clinical areas for delay and back up clinical team when needed
- Room patients when assigned.
- 5 years plus as Prior Authorization Specialist for Internal Medicine and Family Practice for Medications and Referrals
- Notify and Communicate with pharmacies.
- Responsible for STAT documentation (imaging, labs, notes) and scanning to providers.
- Creating telephone encounters from triage line to route to appropriate clinical team member.
- Mail/Fax correspondence and communicating with pharmacies and outside sources to care for patients.
- Preparing pre-op clearances and gathering medical records needed.
- Monitoring in baskets for proper patient care.
Referral Coordinator - Novant Health Lakeside Primary Care - Afton - Afton, US
(2015-08 - 2017-02)
- Handle all outgoing, incoming, and follow up referrals for office.
- Direct contact with specialist office and the scheduling of appointments for physician preference and patient benefit.
- Making contact with insurance companies to verify benefits and networks, to obtain referrals and authorization.
- Communicating with physicians of progress or changes in referral for patient.
- Educating patients on preparations for studies and the responsibility of their own insurance benefits.
- Entering referral information into EPIC (EMR) prior to patient appointment.
- Faxing all pertinent information to specialist prior to patient appointment.
- Maintaining knowledge of available specialist and accepting communication from visiting specialists.
- Relaying any changes in information or procedures to team members by phone, email, or instant messenger.
- Obtain correct insurance information from patients or insurance companies when necessary.
- Support for office manager and office supervisor in assisting or in absence with team to serve our patient.
Clerical Supervisor II - Novant Health - Population Health - US
(2014-05 - 2015-08)
Responsible for referral coordination team in the Novant Health North POD (Patient Oriented Delivery System) PILOT. Directly and providing support for ongoing quality, productivity, and efficiency in the daily operations of the referral department. Office management and supervision of 24 referral coordinators, serving as administrative, providing back up support for all referral related duties and establishing relationships.
Serving as a liaison between referral sources, insurers, hospital staff, and patient. Required knowledge of organization policies and procedure, fiscal management, and human resource management techniques.
- Other duties include but not limited to referrals/orders, scheduling, regulatory compliance, medical records, staff education, and staffing.
- Gathering, analyzing and evaluating data inside and out of EPIC for Novant Health
Referral Coordinator - Novant Health Lakeside Primary Care - Afton - Afton, US
(2010-12 - 2014-05)
- Handle all outgoing, incoming, and follow up referrals for office.
- Direct contact with specialist office and the scheduling of appointments for physician preference and patient benefit.
- Making contact with insurance companies to verify benefits and networks, to obtain referrals and authorization.
- Communicating with physicians of progress or changes in referral for patient.
- Educating patients on preparations for studies and the responsibility of their own insurance benefits.
- Entering referral information into EPIC (EMR) prior to patient appointment.
- Faxing all pertinent information to specialist prior to patient appointment.
- Maintaining knowledge of available specialist and accepting communication from visiting specialists.
- Relaying any changes in information or procedures to team members by phone, email, or instant messenger.
- Obtain correct insurance information from patients or insurance companies when necessary.
- Support for office manager and office supervisor in assisting or in absence with team to serve our patient.
Referral Coordinator/ Patient Service Coordinator - Novant Health Lakeside Family - Highland Creek - US
(2006-09 - 2010-12)
- Responsible for patient check in and out
- Confirming correct demographics and insurance coverage
- Responsible for pulling charts for incoming prescription refills and correspondence.
- Pulling all physician dictation from transcription service and reconciling to match with schedules and doctors sign off.
- Completing charts for medical records and following specific protocol for filing.
- Assuring all office supplies and machinery are properly running and stocked.
- Communicating with team in office to benefit patients for excellent patient care.
Patient Service Coordinator (Float) - Novant Health Lakeside Family Locations - US
(1998-02 - 2006-09)
- Coordinated with multiple departments to ensure operations remained organized and efficient.
- Responded to customer inquiries in a timely and professional manner.
- Resolved complex issues quickly and efficiently while maintaining professionalism.
Staff Assistant - Residency Program - Carolinas Healthcare System - Myers Park - US
(1996-09 - 1998-09)
Customer Service Gate Agent - US Airways - US
(1993-05 - 1996-09)
