Atalia Rickard

Compassionate and detail-oriented Prior Authorization Specialist with six years of expertise in obtaining timely complex authorizations for specialty medications and medical procedures. Proven strength in reducing authorization denials, accelerating turnaround times, and securing coverage for high-cost specialty therapies

Specialty Authorization at Coram/CVS Specialty Infusion (2020-03 – 2026-07)

• Verified insurance coverage for new and current patients regarding medication orders, ordering prescribers, and pharmacy transitions.
• Requested and obtained prior authorizations for patients' medications, DME supplies, and nursing through both medical and pharmacy benefits.
• Secured an 87% approval rate on authorization requests and accurately logged prior authorizations into EPIC and Salesforce systems.
• Collaborated with healthcare providers to streamline clinical documentation, physician orders, and appeal denials, reducing overall processing time by 30%.
• Investigated and resolved insurance denials, by submitting formal appeals supported by medical necessity evidence.
• Scanned, indexed, and uploaded documents from insurance plans, pharmacies, and providers into electronic records system while maintaining strict HIPAA compliance.
• Maintained up-to-date knowledge of prior authorization protocols, payer policies, and industry guidelines.

Clinical Review Technician at Prime Therapeutics (2019-08 – 2020-02)

• Reviewed clinical criteria to determine prior authorization approvals and accurately entered data into claims system for proper adjudication.
• Managed prior authorization and concurrent review processes for 100+ cases weekly, improving care delivery efficiency and cutting processing errors by 15%.
• Identified clinical documentation gaps and coordinated appeals, successfully lowering denial rates by 20%
• Achieved a 15% reduction in approval turnaround time by streamlining communication and offering policy guidance to healthcare providers.
• Analyzed and trouble-shot complex requests within pre-determined SLAs by gathering supporting documentation across multiple internal systems

Switchboard Operator at North Ridge Health and Rehab (2017-12 – 2018-12)

Customer Service Representative at Holiday Stationstores, Inc. (2016-03 – 2017-01)

Associate of Arts (A.A) in Liberal Arts – North Hennepin Community College (2017 – 2021)