Supervisor Prior Authorization Specialist - Ralph H Johnson Medical Center - Remote
(2021-11)
- Manage all facets of the prior and retro authorization processes, ensuring efficient operations and timely responses.
- Address and resolve inquiries related to Prior Authorization using Salesforce.
- Conduct research on accounts requiring appeals due to prior authorization denials.
- Compile and submit appeals to insurance companies, including essential medical records and justifications.
- Resolve rejected authorizations promptly to maintain workflow efficiency.
- Facilitate communication between healthcare providers and insurers for peer reviews.
- Submit and monitor prior authorization requests using designated systems and tools.
- Ensure the accuracy and completeness of all documentation to prevent authorization delays.
- Collaborate with clinical teams, billing departments, and insurance representatives to address authorization concerns.
- Provide management with regular updates on authorization statuses and appeal outcomes.
Advanced Medical Support Assistant - Ralph H. Johnson Medical Center - North Charleston, SC
(2020-05 - 2021-11)
- Coordinated and managed patient scheduling, appointment confirmations, and medical records, ensuring efficient operations and high-quality patient service at Ralph H. Johnson Medical Center.
HR Specialist - Bard - Moncks Corner, SC
(2014-05 - 2020-05)
- Acted as a strategic partner within the manufacturing organization, aligning human capital initiatives with operational objectives.
- Led HR presence on the production floor, shaping workforce strategies and leveraging labor market intelligence for informed talent planning.
- Ensured seamless execution of core HR functions to support operational goals.
- Cultivated a high-performance, compliant, and engaged workplace culture that supported long-term business success.
Customer Service Advisor lead - Trident Medical Center - Charleston, SC
(2011-08 - 2014-08)
- Managed delinquent accounts across diverse lending products, ensuring effective resolution of outstanding balances.
- Communicated with customers to negotiate payoffs and establish payment plans for account settlements.
- Collaborated with billing, accounting, and operational risk teams to streamline account management processes.
- Addressed customer questions, concerns, and inquiries, enhancing overall customer satisfaction.
- Tracked and reported portfolio performance metrics to support data-driven decision-making.
- Assisted with process improvement initiatives to optimize collections operations.
