Wendy D. Phillips

• Responsible for managing and securing prior authorizations for complex and high-cost medical procedures, advanced imaging, specialty services, for outpatient care. ensures compliance with payer requirements, clinical guidelines, and organizational policies to support efficient patient access, minimize care delays, and optimize reimbursement.
• Works independently with minimal supervision, proactively identifying potential authorization barriers, resolving issues, and serving as a resource to clinical and administrative teams. supporting revenue cycle integrity, reducing denials, and ensuring patients receive timely, coordinated care.
• Confirm patient insurance eligibility, benefits, and coverage details to ensure services are authorized appropriately.
• Track pending authorizations, monitor turnaround times, and escalate delays to prevent service denials or scheduling disruptions.
• Review payer policies and authorization guidelines to reduce authorization-related claim denials. Partner with revenue integrity teams to resolve authorization-related denials.
• Work closely with clinical staff, schedulers, and billing teams to ensure all necessary approvals are obtained prior to service delivery.

• Review the revenue cycle and patient access, with a focus on improving the accuracy and productivity by assisting in facilitating, completing operations improvement projects, monitoring and improving quality of the patient account integrity.
• Review clinical information from physician’s office
• Analyzes clinical information to ensure the services requested are authorized according to clinical and payer protocols
• Obtain insurance eligibility, verify member benefits, obtain authorizations for the services requested.
• Validates accuracy of active insurance enrollment in the system prior to authorizing services.

• Effectively follow-up on accounts from insurance and patients in a timely manner.
• Monitor and Manage claims for any outstanding payments.
• Follow-up with payer to check on claim status.
• Update discrepancies in invoices by documenting and communicating to the appropriate department.
• Assist with coding issues, provide missing information to payers to prevent any loss of revenue.
• Verify incoming payments, post provider discounts and document patient’s financial responsibilities.

• Ensure patients' health care benefits covers required procedures, so patient insurance can be billed properly.
• Contact patient's insurance company to verify CPT codes and ICD 10
• Document all information received including authorizations and or denial
• Assist in initiate/obtaining authorizations, Inform physician's office of response received from insurance company
• Perform administrative duties such as answering incoming calls, data entry of patient information correspond to emails
• Responsible for maintaining patient confidentiality, insurance verification

• Prepare laboratory specimens for test results
• Receive and unpack clinical specimens from clients
• Place samples in centrifuges, Pour off serum into transfer tube
• Enter requisitions data into database, label and take to designated test area
• Store excess specimens, resolve and document problem specimens.

• Perform administrative duties such as, greeting visitors and answering phones, data entry of patient information
• Efficient and accurate registration, Admission of patients from doctor's office
• Foster positive public relations through meeting and exceeding customer's needs by directing patients to the right area or scheduling with appointments
• Responsible for maintain patient confidentiality, positive patient identifiers, insurance verification, chart preparation for all patients.

Completed coursework towards Higher learning Phlebotomy Certificate, Pharmacy Technician Certificate

Coursework towards Radiology/ Diagnostic Medical Sonography/Health Administration

Completed coursework towards Medical Coding/ CPC