Mustaki Begum

Results-oriented Clinical Prior Authorization Analyst with 3 years of experience in US Healthcare operations, specializing in medical and pharmacy benefit authorizations. Experienced in reviewing clinical documentation, verifying eligibility and benefits, and coordinating with providers and payers to ensure timely approvals. Strong knowledge of CPT, ICD-10, and HCPCS coding standards, payer guidelines, and utilization management processes.

Consistently meets SLA, productivity, and quality benchmarks while ensuring HIPAA compliance.

Process Analyst – US Healthcare (Prior Authorization) at enGen Global (2023-01 – Present)

• Process 45–52 prior authorization requests daily for inpatient medical and pharmacy benefit services.
• Review and analyze clinical documentation to ensure compliance with payer SOPs and medical necessity guidelines.
• Perform eligibility and benefits verification across Medicare, Medicaid, and commercial insurance plans.
• Coordinate with providers and insurance payers to secure timely approvals.
• Reduced authorization turnaround time by 15% through proactive follow-ups.
• Manage denied cases and submit appeals with accurate documentation to improve approval rates.
• Maintain 98% quality score while consistently meeting SLA and productivity targets.
• Ensure strict adherence to HIPAA regulations while handling confidential patient data.