Elizabeth Koch
Aurora,IL
Summary
Developed strong communication and organizational skills within fast-paced healthcare environment. Demonstrated proficiency in managing complex data entry and ensuring regulatory compliance. Seeking to leverage these skills in new field to drive operational excellence and support organizational goals.
Overview
26
26
years of professional experience
Work History
Referral/Authorization Specialist
Edward Hospital
01.2020 - Current
- Reviews open status referral report/Epic work queues daily and processes referrals to approved, closed or incomplete status based on established policy
- Ensures complete and accurate registration, including patient demographic and current insurance information
- Addresses questions and concerns with patients regarding their referrals and sets guidelines and expectations about the NS_EEH referrals process
- Utilizes online tools to research criteria to verify insurance coverage and need for preauthorization
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Communicates professionally with insurance companies, patients, primary care physicians, specialists and/or facilities regarding authorization as needed
- Contributed to team goals by consistently meeting or exceeding individual productivity targets for processing authorization requests.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Works with the provider to ensure the procedure has correct coding and is approved prior to initiation of procedure/test/treatment
- Assisted in training new team members on company policies and procedures for handling authorization requests.
- Establishes, develops, and maintains good working relationships with hospital departments, health plan representatives and physician office personnel to ensure timely transfer of information to complete the authorization process and promote goodwill
- Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during the authorization process.
- Documents all referral information in Epic
- Ensures strict confidentiality of all health records, member information and meets HIPAA guidelines
- Serve as a Covid Labor Pool Team Lead
- Utilizes Rhyme Live-Auth application to achieve real-time authorization
- Managed approximately 30 incoming calls, emails and faxes per day from customers.'
- Promoted positive customer experiences by addressing concerns or questions related to authorizations in a professional manner.
Referral Specialist 2/Mentor
Carelon
01.2017 - 01.2019
- Responsible for providing support to a clinical team to facilitate the administrative components of clinical referrals for various Carelon medical benefits management services
- Primary duties include initiating and managing clinical referrals for pre-authorization, reviewing referrals for completeness and follows up for additional information if necessary, and responding to inbound calls, initiating exam requests, following established processes, meeting quality and production standards
- Developed strong relationships with external healthcare facilities, fostering a collaborative approach to patient care coordination.
- Assigns escalated referrals to staff as appropriate
- Built professional relationships with service providers.
- Verified insurance coverage and completes pre-authorization for surgical and high-tech radiology (CT, MRI, PET, etc.) while following established process and procedures
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Screened Pre-authorization requests using approved criteria and guidelines
- Enhanced patient satisfaction by promptly addressing inquiries and resolving issues related to referrals.
- Maintained telephone service standards in accordance with departmental guidelines
- Served as training mentor to new personnel after six months of employment.
- Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.
- Streamlined referral processes for increased efficiency, resulting in timely appointments for patients.
- Verified insurance benefits and eligibility for procedures before referring clients.
Polysomnography Technologist
Advocate Good Samaritan Hospital
01.2003 - 01.2017
- Performed attended polysomnograms, MSLT, CPAP, BIPAP, VPAP and O2 titrations
- Performed polysomnograms on research patients using specific protocols
- Interviewed patients and document medical information including history
- Completed new patient files and update information for existing patients
- Effectively educate and communicate with patients regarding pre-testing, testing and post-testing procedures
- Completed Set-up process for diagnostic testing
- Educated patients regarding use and benefits of positive airway pressure and sleep disorders
- Performed direct patient care while maintaining a safe environment
- Completed patient check-in/check-out procedures
- Completed equipment maintenance, troubleshooting, and calibrations as necessary
- Prepared (score) studies for physician review, diagnosis, and dictation
- Maintained inventory of lab supplies
- Served as lab 'Safety Champion' to ensure safety measures and practices are established for patients and staff
- Completed staff schedules
- Completed training and orientation of new personnel.
Communications Operator
Advocate Good Samaritan Hospital
01.1999 - 01.2003
- Effectively managed a high volume of inbound/outbound customer calls
- Referred unresolved customer grievances to designated departments for further investigation
- Managed customer calls effectively and efficiently in a complex, fast-paced call center environment
- Accurately document, research and resolved customer service issues
- Maintained the electronic personnel directory for accuracy
- Completed training and orientation of new personnel.
- Assisted over 100 customers daily by answering questions and transferring to appropriate departments.
- Properly directed inbound calls in phone queues to improve call flow by 70%.
Security Forces Specialist
United States Air Force
01.1999 - 01.1999
- Ensure the safety of all base weapons, personnel, and property
- Direct air bases defense functions and lead individual and team exercises
- Conduct investigations into any on-base incidents
- Train handlers and military work dogs
- Apprehend and detain suspects, secure crime scenes, and testify in judicial proceedings
- Apply life-saving procedures as first responders to disaster scenes
- Participate in team patrol movements, tactical drills, battle procedures, and military operations other than war.
Education
General College Course -
College of DuPage
Glen Ellyn, ILHuman Resources - Talent Acquisition
Coursera
Leadership - Certificate Training
Harvard University
Polysomnography Training Course - Sleep Medicine
Midwest Sleep & Neurodiagnostic Institute
Rockford, ILSkills
- PSG
- MSLT
- CPAP
- BIPAP
- VPAP
- O2
- Proficient in Sandman
- Alice
- Somnoware Sleep Software
- Microsoft Office including Word
- Excel
- PowerPoint
- Adobe Office Suite
- Charting and Documentation
- Prior Authorization
- Clinical research
- Train personnel in all aspects of polysomnography
- Excellent communication skills
- Customer service oriented
- Accurate/Detailed/Efficient
- Excellent planner/Coordinator/Multi-tasker
- Medical terminology knowledge
- Collaborative team player
- Insurance Verification
- Medical terminology expertise
- HIPAA Compliance
- Documentation and paperwork
- Effective communication skills
- Recordkeeping and data input
- Application assessment
- Knowledgeable in Epic
- Telephone Etiquette
- Medicaid knowledge
- Confidentiality
- Microsoft Office
- Documentation And Reporting
- Interpersonal Skills
- Document Preparation
- Self Motivation
- Multitasking
- Effective Communication
- Authorizations knowledge
- Audit Support
- Time Management
- Claims management
- Insurance verification
- Data entry proficiency
- Medical coding
- Documentation and reporting
- Policy interpretation
- Government relations
- Telephone etiquette
- Applicant support and service
- Project management
- Time management
- Problem-solving
- Customer service
- Attention to detail
- Problem-solving abilities
- Multitasking Abilities
- Excellent communication
- Reliability
- Critical thinking
- Organizational skills
- Team collaboration
- Decision-making skills
- Active listening
- Effective communication
- Adaptability and flexibility
- Relationship building
- Team building
- Task prioritization
- Interpersonal skills
- Customer relationship management
- Analytical thinking
- Documentation review
- Deadline management
- Conflict resolution
- Document preparation
- Account reconciliation
- Quality control
- Time management abilities
Contact
Aurora Illinois
Languages
Spanish
Timeline
Referral/Authorization Specialist
Edward Hospital
01.2020 - Current
Referral Specialist 2/Mentor
Carelon
01.2017 - 01.2019
Polysomnography Technologist
Advocate Good Samaritan Hospital
01.2003 - 01.2017
Communications Operator
Advocate Good Samaritan Hospital
01.1999 - 01.2003
Security Forces Specialist
United States Air Force
01.1999 - 01.1999
General College Course -
College of DuPage
Human Resources - Talent Acquisition
Coursera
Leadership - Certificate Training
Harvard University
Polysomnography Training Course - Sleep Medicine
Midwest Sleep & Neurodiagnostic Institute
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