Tonia Hevener
Fishersville
Overview
39
39
years of professional experience
Work History
Insurance Authorization Specialist
Shenandoah Valley Orthopedics and Sports Medicine
Fishersville
05.2003 - Current
- Managed daily workflow related to obtaining authorizations from various health plans including Medicare and Medicaid and commercial carriers.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Notified ordering providers of denied authorizations.
- Coordinated communications between patients, billing personnel and insurance carriers.
- Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
- Input claim, prior authorization, and other important medical data into system.
- Coordinated with healthcare providers to gather necessary patient information for prior authorization requests.
- Responded promptly to inquiries from healthcare providers regarding status of authorizations.
- Provided customer service to patients and healthcare providers, answering questions related to prior authorization and insurance coverage.
- Coordinated with medical staff to provide appropriate documentation when needed for preauthorization requests.
- Coordinated resolutions for issues and appealed denied authorizations.
- Verified insurance eligibility for patients and entered information into the system.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Organized information by using spreadsheets, databases or word processing applications.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Assisted healthcare providers with appeals for denied authorizations, including gathering additional information and documentation.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Completed day-to-day duties accurately and efficiently.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
- Updated and maintained databases with current information.
- Assisted with customer requests and answered questions to improve satisfaction.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Gathered and verified insurance requirements to meet payer requirements.
- Scheduled tests, lab work or x-rays for patients based on physician orders.
- Scheduled and confirmed patient appointments and consultations.
- Obtained PA for services such as diagnostic imaging.
- Compiled and coded patient information or data in appropriate computer system.
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
Retail Store Manager
Corning Revere Factory Store
Waynesboro
06.1986 - 04.2003
- Strengthened work flow productivity by hiring, managing and developing top talent.
- Built and maintained strong working relationships with team members.
- Implemented successful business strategies to increase revenue and target new markets.
- Managed inventory tracking and physical inventory counts to minimize loss.
- Increased store sales by cross-selling complementary items.
- Ensured compliance with all applicable laws, regulations, safety standards, and company policies.
- Balanced sales, reconciled cash and made bank deposits to facilitate opening and closing duties.
- Resolved customer complaints in a professional manner.
- Implemented campaigns and promotions to help with developing goods and services.
- Monitored progress by establishing plans, budgets and measuring results.
- Oversaw storewide merchandising benchmarks to maintain operational excellence.
- Supervised receiving and stockroom activities to identify opportunities with inventory and prevent shrinkage.
- Delegated work to staff, setting priorities and goals.
- Handled cash register transactions accurately while providing excellent customer service.
- Coordinated stock replenishment processes as needed based on sales trends.
- Supervised daily operations of the retail store, including staff scheduling, inventory management and customer service.
- Completed thorough opening, closing, and shift change functions to maintain operational standards each day.
- Prepared weekly schedules to verify proper floor coverage within fiscal guidelines.
- Supervised cash drawer balances and deposits of store receipts.
- Updated and maintained store signage and displays.
- Ensured all safety protocols were followed at all times by staff members.
- Conducted regular meetings with staff members to discuss performance issues or new initiatives.
- Trained and mentored associates to teach daily tasks and procedures.
- Reviewed financial statements and sales or activity reports to measure productivity or goal achievement.
Education
High School Diploma -
Stuarts Draft High School
Stuarts Draft, VA06-1989
Skills
- Insurance verification
- Prior authorization processing
- Patient scheduling
- Medical coding
- Customer service
- Communication skills
- Attention to detail
- Problem solving
- Time management
- Multitasking capacity
- Precertification requirements
- Goal setting
- Reliability
- Professionalism
- CPT coding
- Detail orientation
Timeline
Insurance Authorization Specialist
Shenandoah Valley Orthopedics and Sports Medicine
05.2003 - Current
Retail Store Manager
Corning Revere Factory Store
06.1986 - 04.2003
High School Diploma -
Stuarts Draft High School