Lorena Susnea-litman
San Jose,CA
Summary
Proven Authorization Specialist with a track record of optimizing workflow processes at Khuu Dermatology and enhancing customer engagement at Macy's. Excelled in claims management and effective communication, consistently exceeding productivity targets by mastering medical terminology and insurance verification. Demonstrated adaptability and commitment to continuous education, significantly improving claim resolution efficiency. Supportive Eligibility Specialist with extensive application engagement and dedicated service skills. Bilingual professional with skill to maintain accurate records, schedule appointments and handle various administrative responsibilities. Brings proven track record of success in determining eligibility and resolving complex cases. Works professionally with clients to develop and implement successful strategies for maximizing services and benefits. Skilled in problem-solving and identifying solutions meeting clients' needs.
Overview
17
17
years of professional experience
Work History
Authorization Specialist
Khuu Dermatology
11.2013 - Current
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Contributed to team goals by consistently meeting or exceeding individual productivity targets for processing authorization requests.
- Assisted in training new team members on company policies and procedures for handling authorization requests.
- Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during the authorization process.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Demonstrated adaptability with changing insurance requirements, maintaining up-to-date knowledge through continuous education efforts.
- Ensured prompt resolution of denied claims through comprehensive analysis of denial reasons and timely submission of necessary documentation for reconsideration or appeal.
- Expedited claim processing by submitting complete and accurate information in accordance with payer requirements.
- Trained staff on current eligibility requirements and policies.
Sales Associate
Macy's
07.2007 - 07.2012
- Organized racks and shelves to maintain store visual appeal, engage customers, and promote specific merchandise.
- Handled cash transactions efficiently while adhering to company cash handling policies, ensuring accuracy in all financial exchanges.
- Built relationships with customers to encourage repeat business.
- Managed returns, exchanges and refunds in accordance with store policy.
Education
No Degree - Business Management
University of South Alabama
Mobile, ALSkills
- Claims Management
- Medical terminology expertise
- Insurance Verification
- Prior authorization processing
- Appointment Scheduling
- Documentation and paperwork
- Effective communication skills
- Telephone Etiquette
- Authorizations understanding
Timeline
Authorization Specialist
Khuu Dermatology
11.2013 - Current
Sales Associate
Macy's
07.2007 - 07.2012
No Degree - Business Management
University of South Alabama