Prior Authorization Specialist Resume Sample

Updated on: January 12, 2021
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When writing a resume for a Prior Authorization Specialist job, keep in mind that you are what your resume says you are – as far as the employer is concerned.

So it only makes sense to ensure that your resume is up to the standards that the employer has set.

Your training, experience, and skills should all be made evident in your resume for the Prior Authorization Specialist position. 

Study the example below to get more ideas.

Sample Resume for Prior Authorization Specialist Position

Danial Davidson
80 Gwen Lane | Monsey, NY 10095
(000) 251-7454
dandav @ email . com


PRIOR AUTHORIZATION SPECIALIST

SUMMARY
Passionate and results-oriented Prior Authorization Specialist with hands-on experience in reimbursement and claims processing, and applying billing and coding principles consistent with government regulatory standards. Closely monitor authorization processes for the practice, with a special focus on the clarity of each module. Skilled in obtaining clearance that medical treatments are considered necessary, processing referrals based upon insurance plans and following up on outstanding authorizations, and accurately documenting events in EMRs.

KEY ACHIEVEMENTS AS A PRIOR AUTHORIZATION SPECIALIST
• Successfully obtained prior authorizations for all assigned patients between 2017 and 2020.
• Introduced the concept of prescreening, making authorization processes less cumbersome than before.
• Increased patient data safety by 50% by putting in place system modules that focused on confidentiality.
• Trained a group of prior authorization representatives as part of their induction programs at the organization.

PROFESSIONAL EXPERIENCE

Prior Authorization Specialist
Omnicare Inc., Monsey, NY | 8/2013 – Present

• Receive and verify requests for prior authorizations and ensure that they are administered properly
• Consult with presiding doctors or nurse managers to obtain clearance for the necessity of treatment
• Look through insurance plans in a detailed manner and process required referrals
• Sort medical records and submit them to the carrier in a bid to expedite the authorization process
• Keep medical staff in the loop about any delays or problems in obtaining authorizations
• Apply billing and coding principles in sync with government policies and standards
• Ensure that insurance carriers’ documentation requirements are completed and that all copies are placed in patients’ medical records files
• Verify patients’ benefits and ensure that proper prior authorization and re-authorization is obtained for additional treatment

Prior Authorization Representative
WellCare, Monsey, NY | 2/2006 – 8/2013

• Assisted in verifying requests for pre-authorizations by creating and maintaining liaison with nurse managers
• Reviewed claims, insurance, and rejection orders to determine the type of authorization required
• Obtained all necessary information, including documents and orders on behalf of patients
• Tracked and recorded all communication between insurance carriers and facility representatives
• Worked with referral specialists to assist in running referral reports and served as a backup to the process

EDUCATION
High School Diploma
Monsey High School, Monsey, NY

CORE COMPETENCIES
• Billing and Coding Principles
• Payer Specific Guidelines
• Insurance Liaison
• Medical Records Management
• Patient Benefits Verification
• Prescreening
• Confidentiality Management
• Patient Account Creation
• Data Entry
• Denial Appeals
• Reimbursement Facilitation
• Medical Reviews