Prior Authorization Coordinator Resume Samples

A Prior Authorization Coordinator is accountable for verifying coordinating benefits, addressing patient’s concerns, patient-eligibility process and other matters relating to authorization and turnaround. A well-drafted Prior Authorization Coordinator Resume mentions the following core duties and responsibilities – interviewing and assisting patients, checking their authorization documents, monitoring and tracking authorization of patients; informing supervisors about expired dates, ensuring benefits with insurance providers; obtaining and reviewing insurance authorization referrals; and adhering to state and federal requirements.

While the education requirements vary from employer to employer, the required skills are almost common and include – strong communication skills, the ability to detect minute mistakes; close attention to details; knowledge of medical coding and terminologies; prior work experience and strong typing skills. A college degree is preferred. However, those with a high school diploma and training in the relevant field also qualify for this post.

Prior Authorization Coordinator Resume example

Prior Authorization Coordinator Resume

Objective : Dedicated professional with 2 years of experience in Prior Authorization coordination, adept at managing insurance approvals and ensuring compliance with healthcare regulations. Proven ability to communicate effectively with healthcare providers and patients to facilitate timely access to necessary treatments. Committed to optimizing processes to enhance patient care and streamline operations.

Skills : Healthcare Software Proficiency, Attention To Detail, Insurance Verification, Claims Processing

Prior Authorization Coordinator Resume Example

Description :

  1. Promoted quality and cost-effectiveness of medical care through adherence to utilization management protocols.
  2. Executed Prior Authorization processes to ensure timely and appropriate care delivery.
  3. Communicated effectively with provider groups and health plans to resolve authorization inquiries.
  4. Processed requests for approval, denial, or deferral, ensuring timely resolution.
  5. Managed deferred authorization maintenance, including tracking and follow-up.
  6. Applied client and corporate guidelines to determine approval or denial of medication requests.
  7. Collaborated with clinical program managers to address complex authorization issues.
Years of Experience
Experience
0-2 Years
Experience Level
Level
Entry Level
Education
Education
AAS Health Admin


Senior Prior Authorization Coordinator Resume

Headline : Healthcare professional with over 7 years in Prior Authorization coordination, specializing in insurance verification and regulatory compliance. Expert in liaising with medical providers and patients to ensure prompt approval of necessary treatments. Passionate about enhancing operational efficiencies and improving patient access to care, driving positive outcomes within healthcare settings.

Skills : Healthcare Administration, Billing Knowledge, Documentation Skills, Prior Authorization, Healthcare Policies

Senior Prior Authorization Coordinator Resume Format

Description :

  1. Communicated with patients to gather essential information for processing prescriptions, refills, and applying co-pay cards, fostering loyalty through exceptional service.
  2. Investigated and verified benefits for pharmacy and medical claims, ensuring accuracy and compliance with payer requirements.
  3. Coordinated with financial assistance teams to secure funding for patients requiring medication support.
  4. Initiated and followed up on authorization requests, maintaining communication with insurance carriers to expedite decision-making.
  5. Monitored and reported service issues related to authorizations, advocating for timely resolutions to prevent delays in patient care.
  6. Ensured consistent patient access to medications and therapies, minimizing interruptions in treatment.
  7. Maintained detailed records of interactions and outcomes to support continuous improvement initiatives.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Senior
Education
Education
BSHA


Prior Authorization Coordinator Resume

Objective : Skilled Prior Authorization Coordinator with 2 years of experience in processing insurance approvals and ensuring compliance with healthcare policies. Proficient in collaborating with healthcare professionals to navigate complex authorizations and enhance patient access to critical treatments. Driven to improve operational workflows and deliver exceptional service in fast-paced environments.

Skills : Data Management, Patient Advocacy, Report Generation, Database Management, Scheduling Appointments, Medical Coding

Prior Authorization Coordinator Resume Model

Description :

  1. Processed internal and external requests for injectable drugs, ensuring compliance with insurance guidelines.
  2. Completed insurance forms for various providers, including Blue Cross and Cigna, to facilitate approvals.
  3. Reviewed patient charts to identify necessary lab tests and documentation for authorizations.
  4. Documented all communications with medical staff and pharmacies to maintain accurate records.
  5. Delivered exceptional customer service to patients and vendors, fostering strong professional relationships.
  6. Coordinated the timely delivery of pharmaceuticals in alignment with patient needs and payer requirements.
  7. Communicated clinical inquiries to pharmacy and nursing teams, facilitating direct patient interactions.
Years of Experience
Experience
0-2 Years
Experience Level
Level
Junior
Education
Education
A.S. in Health Sci.

Lead Prior Authorization Coordinator Resume

Summary : Dynamic healthcare professional with over 10 years of expertise in leading Prior Authorization coordination. Skilled in navigating complex insurance processes, ensuring compliance, and optimizing patient access to essential treatments. Proven track record of fostering strong relationships with healthcare providers and enhancing operational workflows to deliver exceptional patient care.

Skills : Insurance Negotiation, Prior Authorization Knowledge, Billing Procedures, Communication Skills, Problem Solving, Time Management

Lead Prior Authorization Coordinator Resume Sample

Description :

  1. Managed and processed prior authorization requests, ensuring adherence to regulatory standards.
  2. Established and nurtured relationships with healthcare providers to facilitate timely authorizations.
  3. Conducted thorough reviews of patient eligibility and insurance claims, resolving issues proactively.
  4. Implemented process improvements that enhanced operational efficiency and reduced turnaround times.
  5. Monitored and maintained accurate records of authorizations, ensuring compliance with internal policies.
  6. Collaborated with interdisciplinary teams to address complex authorization challenges.
  7. Provided training and support to junior staff on best practices in prior authorization coordination.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
B.S. Health Admin.

Prior Authorization Coordinator Resume

Objective : Results-oriented Prior Authorization Coordinator with 5 years of experience in processing insurance approvals and ensuring regulatory compliance. Skilled in effective communication with healthcare providers and patients to facilitate timely access to essential treatments. Eager to leverage expertise in optimizing authorization workflows and enhancing patient care.

Skills : Insurance Coding, Quality Assurance, Record Keeping, Hipaa Compliance, Workflow Management, Research Skills

Prior Authorization Coordinator Resume Format

Description :

  1. Managed daily assignments of prior authorization requests for medical services and durable medical equipment.
  2. Provided comprehensive updates to the team on policy changes, enhancing compliance and operational efficiency.
  3. Handled high volumes of inquiries from healthcare providers, patients, and insurance companies regarding authorization status.
  4. Verified prescriptions and documentation to ensure accurate and timely processing of authorizations.
  5. Entered and tracked durable medical equipment requests in the management system.
  6. Coordinated with logistics teams to facilitate timely delivery of medical equipment.
  7. Implemented process improvements that increased overall team productivity and reduced errors.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Management
Education
Education
B.S. Health Admin.

Associate Prior Authorization Coordinator Resume

Objective : Accomplished Prior Authorization Coordinator with 2 years of experience in managing insurance approvals and ensuring adherence to healthcare regulations. Skilled in facilitating communication between patients and providers to expedite access to essential treatments. Eager to apply analytical skills and improve operational processes for enhanced patient outcomes.

Skills : Medical Terminology, Problem-solving, Organizational Skills, Regulatory Compliance

Associate Prior Authorization Coordinator Resume Example

Description :

  1. Managed incoming calls from patients, healthcare providers, and pharmacists to facilitate prior authorization requests.
  2. Resolved issues and provided timely approvals or denials based on medical necessity criteria.
  3. Maintained accurate records of all pre-authorization activities and outcomes.
  4. Conducted utilization reviews for pre-certifications via web, fax, and telephone.
  5. Coordinated appeals with physicians when treatment requests did not meet medical necessity guidelines.
  6. Worked with quality assurance teams to verify patient demographics and authorization details.
  7. Obtained pre-authorizations with insurance for medications and assisted with billing inquiries.
Years of Experience
Experience
0-2 Years
Experience Level
Level
Entry Level
Education
Education
A.S. in HA

Prior Authorization Coordinator Resume

Objective : Enthusiastic Prior Authorization Coordinator with 2 years of specialized experience in navigating insurance processes and ensuring regulatory compliance. Skilled in fostering effective communication between healthcare providers and patients to expedite treatment approvals. Dedicated to enhancing operational efficiencies and delivering exceptional patient care in a fast-paced environment.

Skills : Microsoft Excel, Word, And Powerpoint, Utilization Management Software, Claims Processing And Management Software, Patient Education, Adaptability, Confidentiality

Prior Authorization Coordinator Resume Sample

Description :

  1. Collaborated with healthcare teams to authorize surgeries and office visits efficiently.
  2. Managed urgent authorizations for same-day appointments, ensuring timely patient care.
  3. Contributed to compliance efforts by addressing AHCCCS guidelines, significantly improving departmental operations.
  4. Streamlined communication between departments to enhance member experience.
  5. Trained new hires on authorization processes, ensuring accuracy and compliance.
  6. Utilized reporting tools to analyze authorization data and support compliance initiatives.
  7. Conducted follow-ups on pending authorizations to optimize workflow and patient access.
Years of Experience
Experience
0-2 Years
Experience Level
Level
Entry Level
Education
Education
AAS-HIT

Assistant Prior Authorization Coordinator Resume

Objective : Accomplished Assistant Prior Authorization Coordinator with 5 years of extensive experience in managing insurance authorization processes and ensuring compliance with healthcare regulations. Adept at collaborating with healthcare professionals and patients to streamline approval workflows, enhancing patient access to necessary treatments and improving operational efficiency.

Skills : Data Entry, Forklift Operation, Keyboarding Proficiency, Order Picking, Packing And Shipping, Electronic Health Records

Assistant Prior Authorization Coordinator  Resume Sample

Description :

  1. Reviewed and validated clinical notes for accuracy to ensure compliance with authorization requirements.
  2. Coordinated billing and prior authorizations for Workers' Compensation cases, enhancing claim efficiency.
  3. Submitted clinical information to various insurers to obtain prior authorizations, utilizing effective communication strategies.
  4. Managed appeals for adverse outcomes, advocating for patient needs and ensuring fair resolutions.
  5. Educated patients on their insurance benefits and prior authorization statuses, fostering transparency and trust.
  6. Trained front desk staff on authorization processes to improve patient experience and operational flow.
  7. Acted as a liaison between third-party billers and healthcare providers to streamline billing processes.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
BSHA

Prior Authorization Coordinator Resume

Objective : Detail-oriented Prior Authorization Coordinator with over 5 years of experience in managing pre-authorization processes for medical services. Proficient in reviewing clinical documentation, ensuring compliance with insurance policies, and facilitating communication between healthcare providers and insurance companies to expedite approvals.

Skills : Data Entry 45 Wpm, Microsoft Office Suite, Conflict Resolution, Insurance Claims Processing, Regulatory Compliance Knowledge, Data Entry Skills

Prior Authorization Coordinator Resume Template

Description :

  1. Processed and evaluated medical claims for service members and veterans, ensuring compliance with insurance policies.
  2. Drafted and dispatched approval/denial letters to patients and providers to facilitate clear communication.
  3. Utilized software systems to manage sensitive data and ensure secure documentation.
  4. Analyzed clinical data against medical terminology and codes to ensure accurate processing.
  5. Provided exceptional customer service by addressing inquiries from healthcare providers and patients.
  6. Coordinated meetings between doctors and pharmacy representatives to enhance collaborative care.
  7. Managed incoming inquiries regarding prior authorizations, providing timely and accurate information.
Years of Experience
Experience
0-2 Years
Experience Level
Level
Entry Level
Education
Education
A.S. Health Sci.

Prior Authorization Coordinator Resume

Objective : Dedicated Prior Authorization Coordinator with a proven track record in efficiently processing authorization requests and appeals. Skilled in utilizing electronic health record systems and insurance portals to expedite approvals. Committed to enhancing patient access to necessary treatments while ensuring compliance with regulatory standards and organizational policies.

Skills : Negotiation Skills, Analytical Skills, Multi-tasking, Technical Proficiency, Confidentiality Practices

Prior Authorization Coordinator Resume Sample

Description :

  1. Gathered and verified all necessary information for insurance authorizations, ensuring accuracy and compliance.
  2. Completed prior authorization requests via online platforms and phone calls to insurance providers.
  3. Maintained and organized all aspects of the credentialing process for healthcare providers.
  4. Informed relevant staff of authorization approvals or denials for timely response.
  5. Conducted follow-up calls to check authorization statuses and documented updates in the CPR system.
  6. Managed spreadsheets to track authorization requests and outcomes efficiently.
  7. Communicated pertinent information to sales staff, ensuring alignment with patient needs.
Years of Experience
Experience
0-2 Years
Experience Level
Level
Entry Level
Education
Education
A.S. in Health Science

Precertification Coordinator Resume

Headline : Seeking a Precertification Coordinator profession with an outstanding career opportunity that will offer a rewarding work environment along with a winning team that will fully utilize management skills.

Skills : Networking, Microsoft Powerpoint, Leadership Development, Team Player, Customer Service, General Office.

Precertification Coordinator Resume Model

Description :

  1. Obtained referrals and/or precertification of ordered services such as office visits, procedures, therapies, referrals, radiology tests and medications for MCR/MCD, MCR/MCD products, commercial carriers and occasionally BWC.
  2. Kept current on various clinical guidelines, CPT & ICD-9 coding practices.
  3. Liaisoned between staff, insurance carriers and patients regarding insurance policy practices, precertification processing and/or an appeal process.
  4. Created documents for efficiency of precertification(s)/appeals, spreadsheets/graphs for statistical purposes, forms and form letters.
  5. Scanned and assigned documents into the McKesson EMR system.
  6. Verified insurance eligibility/benefits.
  7. Able to implement my own templates and computer set up for the highest efficiency.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Junior
Education
Education
Diploma

Precertification Coordinator Resume

Objective : Seeking a position as a Precertification Coordinator at a facility where my experiences will provide phenomenal health care services to all patients. I plan to bring my newly trained skills and intermediate knowledge to your facility in hopes of growth.

Skills : Training Skills, Financial Skills.

Precertification Coordinator Resume Format

Description :

  1. Provided necessary information for authorization and stay/visit re-authorization.
  2. Reviewed information for admission and visit management including type and duration of service, authorization and treatment codes, re-authorization and visit requirements necessary for ongoing treatment and payment.
  3. Actively membered in a patient-centered-team approach in the care of the patient and families.
  4. Worked collaboratively with all team members in achieving shared goals with a consistent focus on quality care.
  5. Participated in quality improvement activities including data analysis, implementing recommendations, evaluating changes and outcomes.
  6. Experienced in ambulatory/physician office setting preferred. 
  7. Knowledged of insurance and managed care companies preferred.
        Years of Experience
        Experience
        2-5 Years
        Experience Level
        Level
        Executive
        Education
        Education
        GED

        Precertification Coordinator Resume

        Headline : To obtain a Precertification Coordinator, responsible for Entering patient insurance authorizations and any pertinent information from the insurance company into the patient account history, Documenting insurance coverage of services to be provided, Notifying case management about interactions with insurance companies regarding services, and also Managing denials or potential denials as described by the insurer.

        Skills : Coordinating Skills, Billing Skills.

        Precertification Coordinator Resume Format

        Description :

        1. Primary contacted outpatient families regarding insurance referring them to the patient accounting department as needed.
        2. Responsible for obtaining complete and accurate insurance information, benefits verification, accurately interpreting benefit plans, and investigating pertinent details.
        3. Notified supervisor of known or potential insurance coverage issues.
        4. Reviewed information for admission and continued visit management including type and duration of service, authorization and treatment codes, re-authorization, and continued visit requirements necessary for ongoing treatment and payment.
        5. Responsible for explaining benefits, the billing process, and financial responsibility to parent/guardian.
        6. Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements.
        7. Worked with a lot of elderly patients and if I could just make one person's day I felt like I accomplished a whole lot.
        Years of Experience
        Experience
        5-7 Years
        Experience Level
        Level
        Executive
        Education
        Education
        GED

        Precertification Coordinator Resume

        Objective : To obtain a fulltime position with a company or organization or business where I may best use my skills, education, and abilities to their fullest extent. Searching for a company with benefits, upward mobility and stability, and competitive salary. Note- I am currently attending Ashford University online to complete my bachelor's degree in Health Informatics.

        Skills : Implementational Skills, Coordinating Skills.

        Precertification Coordinator Resume Model

        Description :

        1. Involved communication with Commercial Insurance Companies and Workers Compensation Nurse Case Managers to verify patient coverage and benefits.
        2. Demonstrated and completed training processes for Knowledge of ICD9 diagnosis coding Knowledge of CPT4 procedural coding Knowledge of Medical terminology Ability to summarize clinical information in writing or orally for Medical Management or Adjusters Knowledge of Mysis and Tiger computer software from registration through finalization of printing charge tickets Required extensive knowledge of medical billing and follow-up, practice management, accounts receivables, in addition to other accounting procedures such as accounts payable and account reporting used for orthopedic practices.
        3. Reviewed of accounting skills see Hertford Gates Health Department on Other related employment.
        4. Responsible for checking insurance eligibility for outpatients at least every 90 days and annually in January and July via electronic medical records and insurance websites.
        5. Appealed for additional services (extended stays, visits, authorization extension, and letter of medical necessity) and refers to additional resources when necessary.
        6. Progressed through career ladder from Rep to Coordinator in three years Responsible for reinventing the training process for new employees, and creating paperless reference and training material.
        7. Worked with insurance companies and MD offices to obtain authorizations for patient's needed medical tests and procedures.
            Years of Experience
            Experience
            2-5 Years
            Experience Level
            Level
            Junior
            Education
            Education
            MS