Prior Authorization Expert / Clinical Pharmacist
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Prior Authorization Specialist and Clinical Pharmacist with hands-on experience managing U.S. healthcare authorizations, insurance verification, and payer-specific requirements. Skilled in precertification, Buy & Bill workflows, and HIPAA-compliant documentation. Strong communicator experienced in coordinating with providers and insurance companies to reduce delays and improve approval turnaround times.
Prior Authorization Specialist at ELUSA HEALTH Pvt Ltd (2024-09 – Present)
Works as Authorisation Specialist in Elusa Health a healthcare services company that helps patients get access to expensive or complex medicines and works mainly behind the scenes between Doctors, Insurance companies, Pharmaceutical companies and Patients.Our main services are Access support, Benefit verification (checking insurance coverage), Prior authorization support. Process prior authorizations for PBMs like Caremed CVS, Optum, Aetna Medicare, Aetna commercial, Humana, UHC abd Insurance payers like Anthem BCBS, BCBS commercial plans, Meritain Health, Medical Mutual. Review clinical documentation to determine medical necessity and eligibility.Ensure step therapy for each drug.
Drug for pain management like Qutenza, Zilretta, Viscosupplementation injections Durolane J7318, SupartzFx J7321. Submit, track, and follow up on authorization requests to reduce delays. Coordinate with providers and insurance representatives to resolve denials.
Maintain accurate authorization records while ensuring HIPAA compliance.
Virtual Medical Assistant at Advance Healthcare Pvt Ltd (2022-01 – 2024-08)
Supported U.S. providers with EHR documentation and SOAP notes. Conducted insurance verification and eligibility checks. Coordinated authorization-related documentation for telehealth services.
Clinical Pharmacist at AZM Rehab Center (2020-01 – 2022-12)
Reviewed treatment plans and advised providers on medication protocols. Ensured accurate clinical documentation aligned with regulatory requirements.
Doctor of Pharmacy in Pharmacy – UOS, Lahore (2015 – 2020)
