Anik Dolin
Prior Authorization Specialist | Quality Assurance & Denial Prevention
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About
Results-driven Prior Authorization Specialist with 4.5+ years in the US Healthcare revenue cycle, known for pairing hands-on authorization expertise with a strong quality mindset. Proven in running pre-submission QA/QC audits, leading Root Cause Analysis (RCA) and CAPA, and enforcing 100% payer-guideline compliance to cut claim denials. Trusted by teams for calibration sessions, peer-to-peer reviews, documentation-gap detection, and training that lifts SLA adherence, accuracy, and Quality KPIs.
Experience
Prior Authorization Specialist at KG Information Systems (KGISL) (2024-05 – 2026-04)
- Audited complex clinical documentation daily through pre-submission QA/QC, ensuring strict adherence to US payer criteria before submission.
- Led calibration sessions and peer-to-peer quality reviews, classifying fatal and non-fatal errors and delivering actionable feedback that reduced processing errors.
- Drove Root Cause Analysis on recurring defects in authorization requests and implemented CAPA that raised First Pass Yield (FPY) and streamlined operations.
- Safeguarded authorization workflows against internal quality policy and external regulatory requirements to minimize claim denial rates.
- Coached team members through targeted training and knowledge-transfer sessions built on error trends, improving overall quality scores and accuracy.
Process Associate at AGS Health (2021-11 – 2024-04)
- Managed recent dates of service, initiated authorizations, and handled clinicals and follow-ups while sustaining high accuracy and SLA performance.
- Navigated complex authorization processes across radiology, oncology, and cardiology with a zero-defect approach.
Voice Process at Medusind Solutions (2021-05 – 2021-11)
- Handled international voice operations for the dental department, consistently following quality guidelines and call-monitoring metrics.
Education
Bachelor of Commerce
Master of Arts – Madurai Kamaraj University (2019)
Bachelor of Arts – Madurai Kamaraj University (2017)
12th Grade – Tamil Nadu Board (2014)
10th Grade – Tamil Nadu Board (2012)
