Kimberly Hall

Authorization Specialist Iii & Preceptor @Centene Corporation

US

Obtained and evaluated data to reflect current metrics and caseload for team to ensure overall compliance with turn-around-times.• Assisted in training new hires regarding policies, job procedures, and overall workplace duties.• Developed and maintained job aides and instructions to improve overall quality of work for the team.• Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.• Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines.• Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination.• Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment.• Performs data entry to maintain and update various authorization requests into utilization management system.• Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer.• Remains up-to-date on healthcare, authorization processes, policies and procedures.• Complies with all policies and standards.

Monmouth University

Bachelor of Social Work, Social Work

Monmouth University

Master's Degree, Clinical/Medical Social Work

Absegami High School

High school diploma