At US Healthcare Operations, I initiate, track, and obtain prior authorizations for outpatient and inpatient diagnostic imaging, including MRI, CT, and PET scans.
I review clinical documentation, physician orders, and CPT and ICD-10-CM codes against payer policies, including eviCore, Carelon, and InterQual.
When an authorization is pending or denied, I follow up with payers, initiate administrative reconsiderations, and schedule peer-to-peer discussions between providers and payer medical directors. I also coordinate with physician offices to obtain missing clinical notes and other required documentation.
I maintain HIPAA compliance and operational turnaround times, with an authorization accuracy and approval rate over 96%. My experience also includes payer portals and EHR/PM systems such as Availity, Optum, Epic, and Cerner.
