Tony D

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.

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

Bachelor of Technology (B.Tech) – Mansarovar Institute of Science and Technology (2018 – 2022)