ABA Health Prior Authorization Specialist - US-Based Facility - US
(2025-08 - 2026-05)
- Lead the end-to-end prior authorization process for ABA and adaptive behavioral services, including Verification of Benefits (VOB), submission, tracking, audits, and renewals—ensuring timely and uninterrupted patient care.
- Coordinate closely with BCBAs, PCPs, payers, and caregivers to streamline service initiation and maintain continuity of care across all stages of treatment.
- Collect, review, and follow up on required documentation such as diagnosis reports, ABA referrals, treatment plans, and clinical notes from providers and caregivers to support accurate authorization requests.
- Prepare, submit, and manage initial, reassessment, and ongoing authorizations using Silna and multiple payer portals, ensuring compliance with payer-specific requirements.
- Proactively follow up with insurance carriers to monitor authorization status, resolve discrepancies, and prevent delays, denials, or service interruptions.
- Navigate a wide range of commercial and Medicaid payers (Aetna, Cigna, UnitedHealthcare/Optum, and multi-state plans), ensuring efficient handling of varying guidelines and workflows.
- Utilize platforms such as Appsmith, Freshservice, Availity, Lucet Portal, QGlobal, and WPS to support authorization processing, tracking, and documentation management.
- Communicate clearly and consistently with caregivers and clients, providing real-time updates on authorization status, required documents, and next steps to ensure a seamless care experience.
Lead Generation Specialist - Direct Client
(2024-06 - 2025-08)
- Managed the end-to-end sales funnel, from lead generation and qualification to coordination with operations for ATM installation and deployment.
- Conducted outbound cold calls to business owners (retail stores, gas stations, and commercial locations) to present ATM placement opportunities and service benefits.
- Performed market research to identify high-potential locations for ATM placements, supporting strategic business expansion and revenue growth.
- Created and managed engaging content across LinkedIn, Facebook, and Instagram to promote services, increase visibility, and attract potential business partners and clients.
Virtual Assistant | Email & Chat Support - Direct Client
(2024-03 - 2025-04)
- Provided administrative support by managing client inquiries, follow-ups, and appointment scheduling via email and chat.
- Created, scheduled, and managed social media content across Instagram, LinkedIn, and Facebook to maintain brand engagement and visibility.
- Maintained accurate client records and internal documentation to support efficient and organized business operations.
- Assisted in resolving client concerns by coordinating timely responses and ensuring effective communication between clients and internal teams.
Prior Authorization Specialist - Everise
(2022-08 - 2024-08)
- Managed high-volume inbound inquiries from patients, physicians, and pharmacists regarding medication prior authorization requests.
- Applied knowledge of insurance verification, eligibility, and ICD-10 coding to ensure accurate data entry and support efficient reimbursement processes.
- Communicated proactively with healthcare providers to provide real-time updates on authorization status, including approvals, denials, and requests for additional clinical information.
- Facilitated submission of prior authorization requests, including refills and new requests, via CoverMyMeds, phone, and fax while ensuring complete medical documentation from hospitals, clinics, and pharmacies.
- Assisted in sending authorization approval and denial letters to providers and facilities, ensuring timely and accurate communication of payer decisions.
Customer Care Representative - Sc Reservations
(2022-02 - 2022-08)
- Handled hotel reservation and rewards inquiries via phone, ensuring smooth issue resolution and high customer satisfaction.
- Delivered timely updates and clear communication to loyalty members regarding case progress and service requests.
- Resolved customer concerns with professionalism and empathy, effectively de-escalating issues while maintaining brand trust and service quality.
Associate Customer Service - Sutherland
(2021-07 - 2022-01)
- Resolved service and billing concerns with a customer-focused approach, ensuring customer satisfaction and retention.
- Handled inquiries related to billing discrepancies, service interruptions, and account updates with professionalism and accuracy.
- Educated customers on available plans, devices, and promotions to support informed purchasing decisions.
- Delivered clear, solution-oriented support, contributing to improved customer experience and long-term customer loyalty.
