Sherry Akers
Roanoke
Summary
Detail-oriented medical prior authorization specialist with extensive experience in obtaining insurance authorizations and coordinating patient care. Adept at reviewing medical documentation, submitting requests, and communicating effectively with healthcare providers, ensuring compliance and accuracy in high-volume environments.
Overview
23
23
years of professional experience
Work History
Authorization Specialist
Lewis Gale Medical Center
Salem
07.2021 - Current
- Processed patient authorization requests efficiently and accurately.
- Communicated with healthcare providers to verify insurance information.
- Reviewed medical records to ensure compliance with authorization guidelines.
- Coordinated with billing department to resolve payment issues related to authorizations.
- Assisted in training new staff on authorization procedures and systems.
- Monitored changes in insurance policies affecting patient authorizations.
- Collaborated with clinical teams to facilitate timely patient care transitions.
- Researched patient eligibility, coverage information, and benefit levels.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Reviewed authorization requests for accuracy and completeness.
- Monitored daily workflow queues within the department ensuring all tasks are completed accurately and timely.
- Provided customer service to internal and external customers related to authorization requests.
- Investigated discrepancies identified during audits of claims submitted for reimbursement by providers.
- Processed prior authorization requests in accordance with departmental guidelines.
- Created spreadsheets utilizing Microsoft Excel for tracking authorization status updates from payers.
- Generated monthly reports detailing productivity metrics such as number of authorizations processed per day, week, month.
- Conducted training sessions for new employees regarding company policies related to the authorization process.
- Ensured timely submission of accurate documentation to support payment of services rendered by providers.
- Assisted in the development of new processes and protocols to improve operational efficiency.
- Prepared appeal letters on behalf of clients when necessary to resolve disputes with insurers.
- Maintained current knowledge of applicable regulations, laws, and standards.
- Analyzed denials received from third party payers to identify trends in denials and develop proactive measures for resolution.
- Participated in meetings with staff members from other departments such as billing and coding teams to provide clarification on policies related to authorizations.
- Attended continuing education seminars on topics relevant to the role such as coding changes or insurance policy updates.
- Entered data into electronic medical record system accurately and efficiently.
- Managed intake of new claims and performed routine follow-ups.
- Explained reasons behind application denials and recommended further action.
- Coordinated with other departments to promote prompt processing of client applications.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Submitted delinquent accounts to collections department or outside resources.
- Reviewed accounts for signs of fraud and non-payment issues.
Field Tech
CIOX
Phoenix
01.2006 - 11.2020
- Conducted audits of medical documentation to ensure accuracy and completeness.
- Maintained detailed records of audit findings, ensuring accurate tracking of corrective actions.
- Utilized electronic health record systems to streamline auditing processes effectively.
- Adhered to HIPAA regulations when handling confidential patient information.
- Developed comprehensive reports on audit findings, delivering actionable recommendations to improve compliance and operational effectiveness.
- Collaborated with department heads on initiatives aimed at improving overall quality assurance processes within the facility.
- Collaborated with healthcare teams to clarify charting inconsistencies and errors.
- Interacted with physicians, nurses, administrators, and other healthcare professionals regarding audit issues.
- Participated in meetings with hospital staff to discuss audit results and corrective action plans.
- Verified that all relevant documents were included in each chart.
- Compiled and analyzed data from medical records to identify trends and inform quality improvement initiatives.
- Provided technical assistance to staff regarding coding guidelines and best practices for clinical documentation.
- Analyzed data for potential areas where improvement may be needed in coding accuracy or completeness of documentation.
- Identified discrepancies in medical records, such as missing or incorrect documentation.
- Provided targeted feedback on documentation practices, contributing to enhanced quality of care and operational efficiency.
Medical Transcriptionist/Unit Secretary
Carilion
Roanoke
06.2003 - 01.2006
- Transcribed medical reports from various specialties using advanced transcription software.
- Reviewed and edited transcripts for accuracy and clarity before final submission.
- Collaborated with healthcare professionals to clarify dictations and ensure completeness.
- Maintained patient confidentiality while handling sensitive medical information.
- Managed workflow efficiently to meet tight deadlines in a fast-paced environment.
- Utilized electronic health record systems for accurate data entry and retrieval.
- Assisted in training new transcriptionists on best practices and company standards.
- Implemented quality control measures to enhance transcription consistency and reliability.
- Transcribed medical dictation from physicians, including patient histories, physical examinations and discharge summaries.
- Ensured proper formatting of transcribed documents according to hospital standards.
- Demonstrated strong knowledge of medical terminology and anatomy.
- Maintained high accuracy rate on daily production of completed reviews.
- Made corrections when needed to grammar, spelling, and syntax.
- Recorded and filed patient data and medical records.
- Identified and corrected errors in reports which could compromise patient care.
- Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature.
- Monitored incoming dictations for timely completion of assigned tasks.
- Produced high-quality transcripts while meeting tight deadlines set by supervisors or clients.
- Reviewed transcribed documents for accuracy and completeness in accordance with established procedures.
- Efficient in transcription software and equipment to work from home.
- Transferred transcribed materials into electronic health records system.
- Performed administrative duties such as filing, faxing, and data entry.
- Researched discrepancies between dictated reports and transcribed documents.
- Reviewed patient records to check accuracy of information and implement updates.
- Created templates for frequently dictated reports in order to streamline workflow processes.
- Utilized multiple computer applications to complete work assignments accurately and efficiently.
- Translated medical jargon and short-hand data into correct terminology.
- Followed federal and state guidelines for release of information.
- Edited drafts originating from speech recognition software to eliminate errors and improve flow.
- Assisted in training new transcriptionists regarding departmental policies and procedures.
- Responded promptly to customer inquiries related to medical records and documentation issues.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Provided technical support for software applications used in the transcription process.
- Interpreted medical terminology and pharmacological information to translate information into coding system.
- Updated database information with newly transcribed documents on a regular basis.
- Collaborated with other departments to ensure accurate completion of all transcription tasks.
- Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
- Conducted quality control checks on completed reports and corrected errors as needed.
- Evaluated audio recordings for clarity prior to beginning transcription work.
- Troubleshot hardware and software problems related to digital dictation systems.
- Thoroughly investigated past due invoices and minimized Number of unpaid accounts.
- Attended training sessions geared to the position to improve skill set and increase speed and accuracy.
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
- Called upon professionals immediately at first sign of problems.
- Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses for orders given.
- Liaised with client's health information management department contact to clarify assignments and deadlines.
- Returned dictated reports for physician's review, signature and corrections and inclusion in patients' medical records.
- Produced medical reports, correspondence and administrative material.
- Performed data entry and data retrieval services for inclusion in medical records and transmission to physicians.
- Set up and maintained medical files and databases.
- Coordinated patient admissions and discharges for efficient unit operations.
- Managed electronic health records and ensured data accuracy for patient information.
- Scheduled appointments and maintained calendars for medical staff and patients.
- Prepared and organized medical charts for daily rounds and assessments.
Education
Bachelor of Science - Medical Management
Bluefield College
Bluefield, WV05-1992
High School Diploma -
Franklin County High School
Rocky Mount, VA06-1986
Skills
- Prior authorization
- Insurance verification
- Authorization processing
- Claims management
- Medical records analysis
- Medical coding
- Billing procedures
- Eligibility procedures
- Compliance review
- Healthcare regulations
- Regulatory compliance
- Quality assurance
- Documentation management
- Data entry proficiency
- Data entry accuracy
- Paperwork processing
- Process improvement
- Fraud detection
- Investigations
- Audit support
- Client assessment
- Patient advocacy
- Public assistance
- Income verification
- Policy compliance
- Policy interpretation
- Appointment scheduling
- Resource information
- Research skills
- Reporting documentation
- Record keeping
- Software proficiency
- Microsoft office
- Communication skills
- Effective communication
- Verbal communication
- Written communication
- Team collaboration
- Cross-functional teamwork
- Customer service
- Conflict resolution
- Problem solving
- Attention to detail
- Reliability
- Prioritization
- Interviewing
- Applicant engagement
- Applicant support
- Assistance eligibility
- Disability awareness
- Workflow optimization
- Confidentiality
- Data input
- Application review
- Application assessment
- Healthcare compliance
Websites
Timeline
Authorization Specialist
Lewis Gale Medical Center
07.2021 - Current
Field Tech
CIOX
01.2006 - 11.2020
Medical Transcriptionist/Unit Secretary
Carilion
06.2003 - 01.2006
Bachelor of Science - Medical Management
Bluefield College
High School Diploma -
Franklin County High School