ELISIA MCCULLOUGH
Fresno
Summary
Experienced Prior Authorization Specialist with 7 years of experience. Proven track record of achieving and maintaining a zero patient backlog during corporate restructuring. Highly attentive to details, ensuring accurate and timely processing of authorizations. Dedicated to providing efficient and effective support to healthcare providers and patients.
Overview
7
7
years of professional experience
Work History
Customer Care Inbound Call's
Evolent Health
08.2024 - 04.2025
Property Management
REGENCY PROPERTY MANAGEMENT
08.2022 - 07.2023
- Achieved a less than 1% vacancy rate
- Resolved conflicts and maintained property budget
- Developed and implemented property management strategies to optimize rental income and reduce property expenses
- Develop and implement property management strategies to attract and retain high-quality tenants and ensure high occupancy rates.
Prior Authorization Coordinator
SANTE HEALTH SYSTEM
03.2022 - 06.2022
- Attaining prior authorization for surgical procedures in a multi physician practice
- Obtains prior authorizations as required by payer, including procurement of needed clinical documentation by collaborating with the Patient Access team and clinical teams.
- Document all prior authorization information including approval dates, billing units, procedure codes, and prior authorization number in patient profile.
- Proactively work on prior authorizations that are due to be expired.
- Provide assistance with reimbursement inquiry requests, including insurance benefit verification, prior authorization, denials and appeals, and other reimbursement issues.
- Identify any restrictions and details on how to expedite patient access.
- Perform research and analysis of patient account issues and strives to resolve problems timely and accurately.
- Ability to work in a team setting, requiring cross-training of multiple functions.
- Ability to prioritize, have excellent customer service and organizational skills, with great attention to detail, and have the ability to work effectively in stressful situations.
Precertification Specialist
Paragon Healthcare, Inc.
01.2018 - 02.2022
- Obtains prior authorizations as required by payer, including procurement of needed clinical documentation by collaborating with the Patient Access team and clinical teams.
- Document all prior authorization information including approval dates, billing units, procedure codes, and prior authorization number in patient profile.
- Proactively work on prior authorizations that are due to be expired.
- Provide assistance with reimbursement inquiry requests, including insurance benefit verification, prior authorization, denials and appeals, and other reimbursement issues.
- Identify any restrictions and details on how to expedite patient access.
- Perform research and analysis of patient account issues and strives to resolve problems timely and accurately.
- Ability to work in a team setting, requiring cross-training of multiple functions.
- Ability to prioritize, have excellent customer service and organizational skills, with great attention to detail, and have the ability to work effectively in stressful situations.
Education
Certificate of Completion Medical Assistant - undefined
High school diploma or GED
Clovis, CA06.2010
Skills
- Clerical experience
- Customer service
- English
- HIPAA
- Medical terminology
- EMR Systems
- Medical Records
- Medical Scheduling
- Computer Operation
- Insurance Verification
- Documentation review
- ICD-9
- CPT coding
- Microsoft Office
- Epic
- ICD-10
Timeline
Customer Care Inbound Call's
Evolent Health
08.2024 - 04.2025
Property Management
REGENCY PROPERTY MANAGEMENT
08.2022 - 07.2023
Prior Authorization Coordinator
SANTE HEALTH SYSTEM
03.2022 - 06.2022
Precertification Specialist
Paragon Healthcare, Inc.
01.2018 - 02.2022
Certificate of Completion Medical Assistant - undefined
High school diploma or GED
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