Healthcare Insurance Specialist | Prior Authorization | Escalations | 10+ Years

Comfortable managing email communication as part of broader omnichannel support work, having handled email and chat channels alongside phone support throughout my career. I know how to keep responses clear, professional, and prompt — whether I'm confirming authorization details with a provider, following up on a pending request, or documenting an issue for the record. I'm organized about staying on top of my inbox, prioritizing urgent items, and making sure nothing sits unanswered too long.

Strong track record of accurate, HIPAA-compliant documentation across patient accounts and provider records. I make sure every authorization approval or denial is properly scanned, logged, and verified for accuracy before it's added to the patient's file. When it comes to denials, I document the specific reason clearly so providers know exactly what happened and what their options are — whether that's pursuing a Peer-to-Peer review or filing an appeal. I've also managed ticketing systems, keeping cases properly tagged, updated, and followed up on so nothing falls through the cracks. Documentation isn't just paperwork to me — it's what keeps the whole authorization process accurate and audit-ready.

Experienced in end-to-end prior authorization processing for both medical and DME services, from initial submission through final resolution. I handle requests via insurance portals, fax, and phone, verify patient eligibility and clinical documentation before submitting, and track authorization status closely to avoid delays. When denials come in, I document the reasons clearly and guide healthcare providers on next steps — whether that's a Peer-to-Peer review or a formal appeal. Comfortable working across multiple insurance payers and portals, with a strong focus on accuracy and keeping patient records fully compliant and up to date.

Accurate and detail-focused when it comes to entering and maintaining patient and account data. I regularly document authorization approvals and denials directly into patient accounts, making sure all details — dates, clinical information, and outcomes — are entered correctly the first time. I'm also experienced updating and tagging tickets in case management systems, keeping records current and easy to track. Whether it's insurance information, eligibility details, or authorization outcomes, I take care to enter data cleanly and double-check accuracy before moving on, since even small errors can cause delays down the line.

Skilled in resolving healthcare claims issues, including billing disputes and payment discrepancies, gained through both provider support and tier-2 escalation work. I identify root causes, coordinate with the right departments, and take full ownership of a case until it's resolved — not just closed. Comfortable reviewing health plan benefits alongside claims to explain coverage decisions and guide providers through appeals when needed.

Experienced in navigating multiple healthcare systems and platforms as part of daily prior authorization and eligibility verification work, including Availity, Waystar, and Salesforce. I use these platforms to verify patient insurance eligibility, submit and track prior authorization requests, and confirm clinical documentation is current before submission. I'm also comfortable logging authorization outcomes and updating patient/provider records within these systems, ensuring information stays accurate and accessible for the healthcare team. Quick to adapt to different portal layouts and workflows, which helps me more efficiently across multiple payers and platforms without sacrificing accuracy.