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)
