Medical Records & Prior Authorization Specialist
Resume:
Regina Sturgill
Mallie, KY *****
ad81r5@r.postjobfree.com
Enthusiastic Medical records and Prior Authorization specialist with 3+ years of experience in managing patient records and health information. Proven track record of providing efficient data collection and entry services while ensuring accuracy and quality. Exceptional ability in time management and multitasking. Excellent interpersonal and communication skills with the ability to build strong relationships with patients, staff and health care professionals.
Authorized to work in the US for any employer
Work Experience
Health Information Specialist
Savista, LLC-Alpharetta, GA
October 2022 to Present
• Organize and file patient information, ensuring confidentiality and compliance with HIPAA regulations
• EPIC Applications
• Office Administration
• Retrieve Surgical & Discharged Patient charts
• Review medical charts for completeness, accuracy, and proper documentation
• Assist healthcare providers in locating specific patient information as requested
• Respond to requests from patients or authorized individuals regarding release of medical records
• Manage the scanning and indexing of paper documents into the electronic health record system
• Train new staff members on proper handling of confidential patient information
• Maintain knowledge of current industry standards related to medical record keeping practices
• Adhere strictly to policies regarding access control measures for protected health information (PHI)
• Ensure compliance with state and federal regulations governing the maintenance and release of medical records
• Maintain a high level of accuracy and attention to detail when handling sensitive patient information
• Manage multiple tasks simultaneously while maintaining a high level of productivity
• Demonstrate strong organizational skills in maintaining an efficient workflow within the medical records department
• Utilize excellent communication skills when interacting with patients, healthcare providers, and colleagues
• Adapt quickly to new software systems or updates in electronic health records
• Contribute to team efforts by sharing knowledge, providing support, and collaborating on projects as needed
• Follow established protocols for document retention, destruction, or archiving as required by law or policy
• Maintain confidentiality at all times when handling sensitive patient information Concierge Support Agent (Temporary)
Sykes Enterprises, Incorporated/Sitel Group-Denver, CO September 2021 to December 2021
• Assist customers with conversion process
• Maintain security of personal and financial information
• Verified account demographics
• Direct customers to Customer Self Services
• Assist with Online Banking
• Advise personal account information
• Process orders for new debit cards per request
• Data entry
• Advise new customers on banking locations
• De-escalate calls
• Transfer calls to appropriate departments
• Direct customers to same day service debit card locations
• Advise on personal and business accounts
• First Call Resolution
• Completed training for a Core position to assist & resolve customer issues Prior Authorization Representative
BroadPath Healthcare Solutions-Tuscon, AZ
November 2020 to May 2021
• Reviewed and processed prior authorization requests for medical procedures, medications, and durable medical equipment
• Verified patient eligibility and insurance coverage to ensure compliance with payer guidelines
• Collaborated with healthcare providers to gather necessary clinical documentation for prior authorization submissions
• Evaluated medical necessity of requested services based on established criteria and guidelines
• Managed a high volume of incoming calls from patients, providers, and insurance representatives regarding prior authorizations
• Maintained accurate records of all prior authorization activities in electronic health record systems
• Collaborated with pharmacy staff to ensure timely processing of medication-related prior authorizations
• Participated in regular meetings with interdisciplinary teams to discuss complex cases requiring additional support or intervention
• Performed thorough reviews of denied prior authorization requests, identifying potential appeals or alternative options for patients' care needs
• Adhered to HIPAA regulations and maintained strict confidentiality when handling sensitive patient information during the prior authorization process
• Contributed to team goals by meeting individual productivity targets while maintaining accuracy in processing
• Ensured compliance with state regulations governing the utilization management process
• Collaborated with case managers and care coordinators to ensure seamless coordination of care for patients requiring prior authorizations
• Participated in quality improvement initiatives to enhance the overall effectiveness of the prior authorization process
• Maintained a high level of professionalism and customer service when interacting with patients, providers, and insurance representatives
• Demonstrated strong attention to detail in reviewing clinical documentation for accuracy and completeness
• Managed multiple priorities effectively, meeting deadlines for processing prior authorization requests
• Maintained a positive attitude even during high-stress situations, contributing to a supportive team environment
Customer Service Representative
Teleperformance-Lehi, UT
May 2019 to November 2020
• Provided assistance to clients through phone and email support
• Identified customer needs and established trust with every encounter
• Maintained up-to-date knowledge and privacy of customer accounts
• Data entry
• Explained products and benefits
• Processed payments, refunds and credits
• Resolved payment and order disputes
• Provided excellent technical support
• Assisted customers with a warm and professional attitude
• Answered general questions
• Resolved customer information and complaints
• Responsible for tracking and maintaining inventory
• Handled online orders and credit card transactions
• Processed Gift Subscription orders
• Emailed Support articles to further assist customers
• Explained order and shipping processes
• Provided policy and service information
• Performed customer service surveys
Member Service Representative for the Centene Medicare Advantage Project BroadPath Healthcare Solutions-Tucson, AZ
November 2018 to February 2019
• Maintained HIPAA and confidentiality guidelines
• Worked from home in private atmosphere while upholding the highest standard of compliance
• Advised members of claims status
• Educated members on the type of coverage/plan they are enrolled in
• Performed search and updates for member's Provider/Pharmacy information
• Explained drug Formularies for better understanding
• Educated members on the available Optional Supplemental Plans in Dental and Vision Services
• Processed payments and set up autopay for members
• Explained copay, coinsurance, and deductible amounts according to member's plan coverage
• Provided exceptional Customer Service
• Assisted members by scheduling medical appointments
• Set up transportation to/from appointments
• Mailed out Plan Materials
• Provided guidance on the Member Portal
• Assisted with Pre-authorizations and Referrals
• Showed concern and empathy while building relationships with members
• Called members back with pertinent information, when needed
• Updated member preferences
• Data entry for member information
Customer Service Agent/Sales Representative
Sykes Enterprises Inc-Chavies, KY
November 2017 to November 2018
• Provide exemplary customer service for the growth of the company
• Promoted product sales to serve the needs of the customer
• Advised customers on the best product for the value of their money
• Obtained monthly payments from checking and credit card accounts
• Performed credit checks
• Showed empathy while making a connection with customer
• Established confidence in my abilities to assist and in our company
• Protected customers personal and financial information
• Data entry
Administrative Assistant/Receptionist
First Presbyterian Church-Hazard, KY
August 2011 to January 2012
• Managed all forms of incoming/outgoing mail, phone, and messages
• Took applications for people who needed assistance
• Filed, Faxed and organized all paperwork
• Managed appointments and activities
• Transferred data from paper to electronic system
• Aid in order/stocking of the required items needed for proper functionality of the facility
• Created brochures/directories and mailers for upcoming facility events
• Organized church events in/for the community
• Cleaned and maintained the Chapel for services
• Assisted pastor Peach and coworker with all other requests Seamstress
Perry Manufacturing-Hazard, KY
September 2005 to December 2007
• Worked in Assembly
• Manually operated an electric sewing machine
• Responsible for creating the bottom hem on Cintas work shirts
• Maintained and organized work area and equipment
• Strived to improve speed and quality
• Insured that shirt hems were at or above specification Logistics Coordinator
TFE Adidas Factory-Burlington, KY
January 2003 to December 2004
• Packaging and Shipping
• Prepared, scheduled and arranged product for pick up and delivery
• Completed and filed all required paperwork on shipments
• Managed the scheduling of appointments and activities
• Entered shipping and order data into system
• Operated forklift and managed movement and placement of items Education
Associate of Applied Science in Medical Information Technology Hazard Community & Technical College - Hazard, KY
January 2016 to May 2018
Graduate in Business & Office Technology
Hazard Community & Technical College - Hazard, KY
1993 to 1994
Skills
• Medical billing
• EMR systems
• Quality assurance
• Medical coding
• Search engines
• Clerical experience
• Computer operation
• Order fulfillment
• Microsoft Office
• Logistics
• Financial concepts
• Conflict management
• Medical terminology
• Accounting
• Medical records (4 years)
• Documentation review
• Customer support
• Research
• Windows
• Records management
• Medical documentation
• HIPAA
• Manufacturing
• Salesforce
• Insurance verification
• Avaya
• Data entry
• Call Center
• CPT Coding
• Microsoft Outlook
• ICD-10
• Computer literacy
• Adobe Acrobat
• ICD Coding
• Microsoft Access
• Microsoft Word
• Data collection
• EHR systems
• Computer skills
• Banking
• Epic
• Medical Scheduling
• Utilization Management
Awards
The Presidents Honor List
January 2018
For a perfect 4.0 GPA
The President’s Honor List
May 2018
For a perfect 4.0 GPA
Certifications and Licenses
Medical Coding Certification
May 2018 to Present
Certified Electronic Health Records Specialist
May 2018 to Present
Medical Receptionist
May 2018 to Present
Hospital Admissions Specialist
May 2018 to Present
Medical Unit Coordinator
May 2018 to Present
Additional Information
Diploma earned for:
• Medical Records Specialist
• Medical Administrative Assistant
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