Kisa Bivins
Decatur
Summary
Healthcare professional with extensive experience in prior authorization coordination, committed to improving patient access to necessary treatments. Known for effective collaboration and delivering results in dynamic healthcare environments. Possesses strong analytical skills and attention to detail, ensuring smooth operations and high-quality service.
Overview
28
28
years of professional experience
Work History
Referral/Prior Authorization Coordinator
South Dekalb Family Physicians
03.2023 - Current
- Initiate specialist referrals, insurance authorizations, imaging pre-certifications, medication prior authorizations, home health/ hospice referrals, and DME orders for multi-provider practice
- Arrange STAT outpatient imaging, specialist consultations, and hospital admissions
- Initiate prior authorizations and optimized turnaround times for responses, collaborating closely with physicians and clinical staff to expedite necessary treatments.
- Verifie eligibility and compliance with authorization requirements for service providers.
- Prepare and distribute denial letters, detailing reasons for denial and possible appeal measures.
- Fielde telephone inquiries on authorization details from plan members and medical staff.
- Triage unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Expedite the approval process for vital medications by maintaining a strong working relationship with insurance providers.
- Provide support for patients navigating complex medical systems, offering guidance and assistance throughout the prior authorization process.
- Coordinate referrals through insurance and other medical specialists and documented details in patient charts.
- Track referral submission during facilitation of prior authorization issuance.
- Register and verify patient records before triage with most up-to-date information.
- Obtain payments from patients and scan ID and insurance cards.
- Schedule patient appointments in respective doctors' calendars and follow up with reminder phone calls.
- Perform various administrative tasks by filing, copying and faxing documents.
- Developed and maintain productive working relationships with healthcare providers.
- Train new staff on front office processes and procedures
Registered Medical Assistant/ Back-office Coordinator
Midha Medical Clinic
07.2015 - 02.2023
- Performed essential administrative tasks such as scheduling appointments, updating records, and coordinating referrals.
- Prescription refill and prior authorization
- Maintained strict confidentiality while handling sensitive patient information in accordance with HIPAA guidelines.
- Increased efficiency in the workplace by organizing and maintaining a clean and functional work environment.
- Prepared patients for exam and treatment, including obtaining detailed medical history, review of system, and social history
- Heavy volume phlebotomy
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Completed thorough chart reviews to ensure proper documentation of all pertinent medical information.
- Contributed to successful health outcomes by effectively communicating between patients and providers about treatments, medications, or follow-up instructions.
- Taught patients about medications, procedures, and care plan instructions.
- Strengthened patient-provider relationships through compassionate communication and attentive listening skills.
- Reduced wait times for patients by swiftly triaging incoming cases based on urgency or severity of symptoms.
- Oriented and trained new staff on proper procedures and policies.
Medical Assistant
Georgia Nephrology Referral Center
08.2013 - 04.2015
- Routed phone calls to the appropriate on-call physician to ensure patient cared for promptly and accurately
- Instructed patients regarding their medications and specialized diets
- Communicated with patients and insurance agencies to ensure proper authorizations and procedure precertification
- Performed medical records management, including filing, organizing and scanning documents.
- Coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.
- Ensured patient safety and comfort during examinations, effectively addressing concerns and answering questions.
- Facilitated seamless patient care with thorough and accurate documentation of medical histories, vital signs, and medications.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Sanitized, restocked, and organized exam rooms and medical equipment.
Medical Office Assistant
Dr. John Obrien (Dermatology)
07.2012 - 08.2013
- Provided patient education, both during pre- and post-op care
- Collected co-pays and deductibles from patients upon check-in at clinic
- Ordered tests and supplies for the office
- Greet and assist patients, called with appointment reminders
Medical Assistant
Mount Auburn Nephrology
03.2009 - 07.2011
- Prepare and complete patient charts, ensuring accurate and up to date information
- Identified critical labs and properly routed chart for resolution
- Obtaining medical records releases from patients
- Track patient’s insurance authorizations, referrals, and precertification
Medical Office Assistant
Dr. Hugh Spruell (Rheumatology/Internal Medicine)
09.2004 - 05.2008
- Obtained lab reports and contacted patients with results in a timely manner
- Light transcription of doctor notes into patient charts
- Answered multi-line phones and scheduled appointments
Personnel Administrative Specialist
U.S. Army (Active Duty/Reserves)
06.1997 - 09.2004
- Honorable discharge
Telecommunications Assistant
MCI Telecommunications
02.2003 - 02.2004
- Maintained confidentiality standards, provided customer service, and handled customer complaints in a timely manner
Customer Service Representative
Pioneer Loan Services
05.2000 - 09.2002
- Assisted soldiers and their families with loan application process, gathered and submitted necessary documentation to evaluate credit worthiness
Education
Associate of Science - Business Administration
Georgia Piedmont Technical College
05-2022
Medical Office Assistant Program - undefined
Concorde Career College
01.2004
High School Diploma -
El Camino High School
Oceanside06-1997
Skills
- Medical Authorizations
- Referrals
- Prior/ Retro Authorizations
- Precertification
- Insurance benefit coverage and verifications
- HIPAA compliance
- EMR systems
- ICD-10 and CPT coding
- Medical terminology knowledge
- HIPAA compliance
- Strong organization
- Direct patient care
Timeline
Referral/Prior Authorization Coordinator
South Dekalb Family Physicians
03.2023 - Current
Registered Medical Assistant/ Back-office Coordinator
Midha Medical Clinic
07.2015 - 02.2023
Medical Assistant
Georgia Nephrology Referral Center
08.2013 - 04.2015
Medical Office Assistant
Dr. John Obrien (Dermatology)
07.2012 - 08.2013
Medical Assistant
Mount Auburn Nephrology
03.2009 - 07.2011
Medical Office Assistant
Dr. Hugh Spruell (Rheumatology/Internal Medicine)
09.2004 - 05.2008
Telecommunications Assistant
MCI Telecommunications
02.2003 - 02.2004
Customer Service Representative
Pioneer Loan Services
05.2000 - 09.2002
Personnel Administrative Specialist
U.S. Army (Active Duty/Reserves)
06.1997 - 09.2004
Medical Office Assistant Program - undefined
Concorde Career College
Associate of Science - Business Administration
Georgia Piedmont Technical College
High School Diploma -
El Camino High School
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