Sallie Ice
Kearney
Summary
Dependable Prior Authorization Specialist with a career spent handling various administrative responsibilities in fast-paced settings. Reliable individual dedicated to finding solutions to issues and obtaining prior authorization information for patients. Ready to tackle new challenges in an office-based environment.
Overview
46
46
years of professional experience
3
3
years of post-secondary education
Work History
Prior Authorization Specialist
Bryan Health Kearney
Kearney
03.2024 - Current
- Processed prior authorization requests for various medical services and procedures.
- Communicated with healthcare providers to obtain necessary documentation for approvals.
- Reviewed patient records to ensure compliance with insurance policies and guidelines.
- Coordinated with insurance companies to clarify coverage details and requirements.
- Maintained accurate and organized records of authorization requests and outcomes.
- Monitored pending authorizations to ensure timely responses from insurance providers.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Notified ordering providers of denied authorizations.
- Maintained accurate records of all authorization activities in the database system.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Provided guidance to providers regarding the prior authorization process.
- Developed relationships with external vendors providing pre-authorization services.
- Processed appeals in a timely manner as per policy guidelines.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
Insurance Referral Specialist
UC Health Pueblo
Pueblo
05.2022 - 03.2024
- Notified various insurances of patients' admissions into the hospital via phone, fax and websites obtaining authorizations for admission if necessary.
- Notified various insurances of patients' observation stays in the hospital via phone, fax and websites obtaining authorizations if necessary.
- Notified VA through Triwest website of patients' visits to the ER, observation stays and inpatient admissions obtaining authorizations.
- Searched for insurance for patients listed as self-pay adding insurance to accounts if found.
- Answered insurance companies questions regarding patients' hospital encounters; reason for stay, length of stay, dates of stay, ICD and CPT codes.
- Checked for medical necessity for Medicare patients' inpatient stays and same day surgery procedures.
- Determined if same day surgery Medicaid patients' procedures required authorization obtaining authorization if necessary.
Remote Radiology Medical Transcriptionist
UC Health Pueblo
Pueblo
05.2014 - 05.2022
- Transcribed medical reports for various specialties ensuring clarity and accuracy.
- Reviewed and edited transcription drafts for grammar and medical terminology.
- Utilized electronic health record systems to access patient information efficiently.
- Maintained confidentiality of patient information in compliance with HIPAA regulations.
- Collaborated with healthcare professionals to clarify ambiguous dictations promptly.
- Managed workload effectively to meet tight deadlines consistently throughout shifts.
- Ensured proper formatting of transcribed documents according to hospital standards.
- Demonstrated strong knowledge of medical terminology and anatomy.
- Maintained high accuracy rate on daily production of completed reviews.
- Made corrections when needed to grammar, spelling, and syntax.
- Identified and corrected errors in reports which could compromise patient care.
- Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature.
Remote Senior Healthcare Documentation Analyst
M*Modal
Franklin
02.2012 - 05.2014
- Qualified in quality assurance in which I ensured accurate and complete demographics and health information documented in reports.
- Adhered to turnaround times
- Notified customer of misinformation or discrepancy.
- Provided oversight of 5-10 documentation specialists.
- Provided feedback to documentation specialists.
- Notified supervisor of potential issues.
- Work audit score of 99.65%.
- MME of the month for July 2013.
Remote Third Tier Medical Transcriptionist/Editor
Dictation Services Group
Atlanta
10.2007 - 02.2012
- Transcribed/edited acute care voice files.
- Adhered to turnaround times.
- Notified quality assurance of potential issues.
- Work audit score of 99% accuracy rate.
Remote Medical Transcriptionist/Editor
MedQuist
Mount Laurel
12.1999 - 12.2008
- Transcribed/edited acute care voice files.
- Performed quality assurance during backlog.
Remote Medical Transcriptionist
Southern Colorado Medical Transcription
Pueblo
12.1995 - 04.2000
- Transcribed dictated reports from cassette tapes - clinics and physicians' offices
- Printed reports and delivered back to employer.
Incomplete Medical Records Clerk
Parkview Medical Center
Pueblo
06.1980 - 11.1985
- Ensured medical records complete and accurate.
- Notified physicians of any deficiencies.
- Maintained and monitored physician suspension list.
- Filed loose reports.
- Answered telephone and directed calls as appropriate.
- Received employee of the month.
Education
Bachelor of Science - Health Information Management
Bellevue University
Bellevue, Nebraska, NE 01.2014 - 01.2015
Associate of Applied Science - Health Information Technology
National American University
Rapid City, SD 06.2011 - 06.2013
Skills
- Prior authorization processing
- Insurance verification
- Compliance assurance
- Clinical documentation
- Healthcare regulations
- Effective communication
- Attention to detail
- Problem solving
- Time management
- Team collaboration
- Customer service
- Records maintenance
- HIPAA compliance
- Provider relations
- Knowledgeable in MS Word, MS Excel, MS PowerPoint, Epic, DocQscribe, Acuity, Meditech, ChartNet, PowerScribe, various word expander software programs
Timeline
Prior Authorization Specialist
Bryan Health Kearney
03.2024 - Current
Insurance Referral Specialist
UC Health Pueblo
05.2022 - 03.2024
Remote Radiology Medical Transcriptionist
UC Health Pueblo
05.2014 - 05.2022
Bachelor of Science - Health Information Management
Bellevue University
01.2014 - 01.2015
Remote Senior Healthcare Documentation Analyst
M*Modal
02.2012 - 05.2014
Associate of Applied Science - Health Information Technology
National American University
06.2011 - 06.2013
Remote Third Tier Medical Transcriptionist/Editor
Dictation Services Group
10.2007 - 02.2012
Remote Medical Transcriptionist/Editor
MedQuist
12.1999 - 12.2008
Remote Medical Transcriptionist
Southern Colorado Medical Transcription
12.1995 - 04.2000
Incomplete Medical Records Clerk
Parkview Medical Center
06.1980 - 11.1985