Aftab Hassan

Detail-oriented Eligibility, Benefits, and Prior Authorization Specialist with over more than one year of experience managing end-to-end prior, retro, and GAP authorizations across cardiology, physical therapy, behavioral health, and Radiology specialties. Skilled in insurance verification, benefits and coordination-of-benefits (COB) review, CPT/ICD-10 order validation, authorization initiation, denial management, and appeals, with a strong record of collaborating with AR teams to resolve claim denials and accelerate reimbursement. Experienced navigating payer portals and clearinghouses across multiple commercial and government payers, researching shifting payer policies, building process documentation, and maintaining HIPAA-compliant handling of protected health information (PHI).

Eligibility, Benefits & Prior Authorization Specialist at Physician Revenue Group (2025-05 – Present)

• Authorization processing: Managed prior, retro, and GAP authorizations end-to-end for practices spanning physical therapy, behavioral health, mental health, and cardiac health.
• Eligibility & benefits verification: Verified active patient insurance coverage, deductibles, co-pays, co-insurance, and coordination of benefits (COB) across multiple commercial and government payers ahead of authorization submission to reduce turnaround time and avoid claim rejections.
• Order & referral review: Reviewed incoming clinical referrals and orders to confirm demographic, insurance, CPT, and ICD-10 data accuracy before initiating authorizations.
• Payer research: Navigated payer portals, provider manuals, and policy updates to clarify ambiguous or shifting prior-authorization requirements, and escalated via phone when needed.
• Denials & appeals: Investigated and resolved authorization-related denials, prepared and submitted appeals, and tracked case outcomes to closure.
• AR collaboration: Partnered closely with the AR team to identify root causes of claim denials and support timely, accurate reimbursement.
• Multi-payer experience: Worked across numerous payers including BCBS, VA, Meridian, Medicare, Medicaid, TheraMatrix, and Oscar, adapting to each payer's authorization requirements and workflows.
• Portal proficiency: Used authorization portals and clearinghouses such as Availity, eviCore, Cohere, and Evolent, along with other payer-specific systems, to submit and track requests.
• Documentation & reporting: Documented authorization status directly in the EMR, applied strong Excel skills to track cases and denial trends, and maintained internal reference notes on payer requirements.
• Compliance: Consistently followed HIPAA regulations to safeguard patient health information (PHI) throughout the authorization and claims process.

Mphil in Mathematics – Riphah international university