Burri PruthviRaj

To be associated with an organization which gives me an ample opportunity to explore my knowledge and enable me to explore my skills in the direction of company's growth in my professional career.

Insurance Authorization Specialist - Ensemble health partners of India

(2026-04 - 2026-07)

• Responsible for obtaining prior authorizations for diagnostic procedures and services from insurance providers.
• Review patient insurance benefits, eligibility, and coverage requirements to ensure timely authorization approvals.
• Coordinate with healthcare providers, insurance companies, and patients to facilitate efficient authorization processes.
• I have experience on provider payer portals like Avility, evolent, UHC, Evicore, Humana, cohere, UMR and Geha.
• Maintain accurate documentation and ensure compliance with payer guidelines and organizational policies.
• Monitor authorization status, follow up on pending requests, and resolve authorization-related issues to support uninterrupted patient.

Senior associate - Primera medical technologies

(2022-04 - 2026-04)

I worked four years' experience in Eligibility benefit verification, Prior authorization and also worked as Medical records reviewer in the department of both patient access and health information management

• I have experience in healthcare administration and front end revenue cycle management (RCM).
• I expert in handling complex patient registration and financial counselling. I have comprehensive knowledge of in-patient (IP) and out Patient (OP) workflows.
• Maintain an accuracy rate in patient demographic and clinical entry within the hospital information system (HIS).
• I have experience on provider payer portals like Avility, OneSource, Clearance, cohere, Cigna, WPS and Palmetto.
• I have good knowledge in insurance types like Medicare, Medicaid, Managed Medicaid and Commercial insurances.
• Expert in insurance eligibility verification and Prior authorization.
• I have a good knowledge upon medical terminology.
• I have a good knowledge upon US health care process.
• I have a good knowledge upon RCM process and also ROI process.
• I am working upon EMR applications like Epic, one content and Medi-tech.
• I analysed data to identify trends and also increased the operational efficiency.
• I successfully negotiated key contracts with clients and also presented the findings and recommendations to the senior management.
• Train new joiners on registration protocols and hospital software systems.

M.PHARMACY - Pharmaceutics - Gokaraju Rangaraju college of Pharmacy, Bachupally, Hyderabad (2020)

B. PHARMACY - Chaitanya college of pharmacy education and research, Hanamkonda (2018)

INTERMEDIATE - Sri Chaitanya junior kalashala, Vijayawada (2014)

S.S.C - Sharada English medium high school, Thorrur (2012)