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Willard James
Medical Authorization Specialist
Summary
Highly motivated and experienced Medical Authorization Specialist with a proven track record of evaluating over 1,000 medical records and authorizations per month. Expertise in medical terminology, patient insurance verification, and authorization request processing. Skilled in negotiating with insurance companies to obtain approvals for complex and challenging authorization requests. Proficient in utilizing specialized software and technology to track and manage authorization requests. Committed to streamlining authorization workflows and improving efficiency.
Education
Bachelor’s Degree in Health Information Management
March 2015
Skills
- Proficient in Protected Health Information (PHI) compliance.
- Expertise in medical terminology.
- Patient insurance verification.
- Authorization request processing.
- Prior authorization workflow management.
- Exceptional communication and interpersonal skills.
Work Experience
Medical Authorization Specialist
- Negotiated with insurance companies to obtain approvals for complex and challenging authorization requests.
- Developed and implemented internal processes to streamline authorization workflows and improve efficiency.
- Trained and supervised new staff on medical authorization procedures and industry best practices.
- Utilized specialized software and technology to track and manage authorization requests.
Medical Authorization Specialist
- Evaluated over 1,000 medical records and authorizations per month, ensuring adherence to insurance policies and regulations.
- Processed and adjudicated prior authorizations for a variety of healthcare services, including surgeries, therapies, and medications.
- Reviewed medical necessity criteria and determined coverage eligibility for patients, maximizing insurance reimbursements.
- Collaborated with physicians and care providers to gather necessary clinical documentation and support authorization requests.
Accomplishments
- Successfully implemented a new electronic authorization system, reducing processing time by 20% and improving overall efficiency.
- Developed a comprehensive training program for new staff, ensuring a smooth onboarding process and highquality service delivery.
- Collaborated with medical teams to develop clinical criteria for authorization decisions, ensuring alignment with best practices.
- Led a crossfunctional team in the implementation of a new patient communication system, improving patient satisfaction and reducing authorization turnaround time.
- Developed and implemented a quality control process for authorization decisions, ensuring accuracy and consistency in patient care.
Awards
- Recognized for exceptional performance in data analysis and utilization, leading to increased authorization approval rates.
- Received recognition for outstanding customer service skills, consistently exceeding expectations in patient and provider interactions.
- Awarded for innovative contributions to the optimization of authorization processes, resulting in significant cost savings.
- Recognized for expertise in regulatory compliance, maintaining a 100% success rate in internal audits.
Certificates
- Certified Medical Authorization Specialist (CMAS)
- Certified Professional Coder (CPC)
- Registered Health Information Technician (RHIT)
- Certified Health Data Analyst (CHDA)
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How To Write Resume For Medical Authorization Specialist
Highlight your experience and expertise.
Quantify your accomplishments and use specific examples to demonstrate your skills.Showcase your knowledge of medical terminology and insurance policies.
This is essential for success in this role.Emphasize your ability to negotiate and communicate effectively.
You will need to be able to work with insurance companies and healthcare providers.Demonstrate your commitment to quality and accuracy.
This is a critical aspect of medical authorization.
Essential Experience Highlights for a Strong Medical Authorization Specialist Resume
- Evaluated medical records and authorizations for accuracy and adherence to insurance policies and regulations.
- Processed and adjudicated prior authorizations for a variety of healthcare services, including surgeries, therapies, and medications.
- Reviewed medical necessity criteria and determined coverage eligibility for patients, maximizing insurance reimbursements.
- Collaborated with physicians and care providers to gather necessary clinical documentation and support authorization requests.
- Negotiated with insurance companies to obtain approvals for complex and challenging authorization requests.
- Developed and implemented internal processes to streamline authorization workflows and improve efficiency.
- Trained and supervised new staff on medical authorization procedures and industry best practices.
Frequently Asked Questions (FAQ’s) For Medical Authorization Specialist
What is a Medical Authorization Specialist?
A Medical Authorization Specialist is responsible for reviewing and approving requests for medical care from patients. This may include reviewing medical records, determining if the care is medically necessary, and negotiating with insurance companies to ensure coverage.
What are the qualifications for a Medical Authorization Specialist?
Most Medical Authorization Specialists have a bachelor’s degree in health information management or a related field. They also typically have experience in medical insurance and billing.
What are the job duties of a Medical Authorization Specialist?
The job duties of a Medical Authorization Specialist may include reviewing medical records, determining if the care is medically necessary, negotiating with insurance companies to ensure coverage, and providing customer service to patients.
What is the salary for a Medical Authorization Specialist?
The salary for a Medical Authorization Specialist can vary depending on experience and location. However, the median salary is around $55,000 per year.
What is the job outlook for a Medical Authorization Specialist?
The job outlook for a Medical Authorization Specialist is expected to be good over the next few years. This is due to the increasing demand for healthcare services and the need for qualified professionals to manage the authorization process.