Mark Dunton

Healthcare professional with 5+ years of experience in payer-side operations, prior authorization management, medical appeals, and claims resolution. Skilled in reducing authorization denials, ensuring HIPAA compliance, and delivering empathetic customer support. Adept at collaborating with physicians, internal teams, and insurance payers to streamline workflows and enhance patient care delivery.

Healthcare (Prior Authorization Intake & Billing Specialist) - Genpact LLC

(2023-07 - 2026-07)

• Managed end-to-end prior authorization process from intake through approval for healthcare services and DME rentals.
• Reviewed patient records and payer requirements to ensure accurate and compliant submissions.
• Submitted and tracked prior authorization requests through multiple insurance portals.
• Conducted proactive follow-ups with insurance payers to expedite approvals.
• Prepared and submitted medical necessity appeals with supporting documentation.
• Reduced authorization denials through meticulous documentation review.
• Collaborated with physicians and internal teams to ensure timely patient care.
• Maintained accurate records while ensuring HIPAA compliance.
• Assisted with billing and collections related to authorization and reimbursement.

Healthcare Customer Service Representative - Carelon Global Solutions

(2021-11 - 2023-06)

• Handled high-volume inbound calls from patients, providers, and insurance representatives.
• Verified patient eligibility and benefits including copays, deductibles, and coverage limitations.
• Assisted members and providers with claims inquiries, payment status, and reimbursement concerns.
• Provided guidance on prior authorization requirements and submission processes.
• Educated callers on healthcare benefits, insurance policies, and billing procedures.
• Resolved customer concerns efficiently while maintaining high satisfaction standards.
• Documented all interactions accurately within company systems.
• Coordinated with internal departments and insurance carriers to resolve complex issues.
• Ensured compliance with HIPAA regulations and industry standards.

Bachelor of Science - Education - Capiz State University (CAPSU) (2017-03)