Tony D
Prior Authorization Specialist | U.S.Healthcare Operations
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About
Detail-oriented Prior Authorization Specialist with over 3 years of experience managing end-to-end authorization workflows in healthcare settings. Proven expertise in insurance verification, clinical documentation review, HIPAA compliance, and multi-EHR environments. Recognized for improving turnaround times, maintaining high approval accuracy, and delivering clear patient communication.
Strong analytical and problem-solving skills with a commitment to operational excellence and patient satisfaction.
Experience
Prior Authorization Specialist at Workflow Mgmt & Optimization, Inc. (2023-02 – Present)
- Manage prior authorization requests for medical services, ensuring compliance with payer guidelines and insurance policies
- Verify patient insurance eligibility, benefits, and coverage to prevent delays and denials
- Maintain diligent follow-ups with insurance providers, achieving a 95% authorization approval rate
- Review and validate clinical documentation to ensure completeness, accuracy, and HIPAA compliance
- Collaborate with physicians, clinical staff, and billing teams to obtain required medical records and supporting documents
- Educate patients and families on insurance coverage, authorization requirements, and next steps, improving patient understanding and satisfaction
- Utilize multiple Electronic Health Record (EHR) systems to track, document, and resolve authorization cases efficiently
Education
Bachelor of Technology (B.Tech) – Mansarovar Institute of Science and Technology (2018 – 2022)
