Jada Suit, CRCR, CSPR

HFMA CRCR- and CSPR-certified revenue cycle professional specializing in prior authorization, insurance verification, benefits investigation, payer policy research, medical necessity review, and financial clearance across commercial, Medicare, and Medicaid plans. Experienced in researching payer-specific authorization criteria, coverage limitations, documentation requirements, and submission pathways; preparing and tracking authorizations through CoverMyMeds, Availity, payer portals, Epic, Cerner, and Athena; and supporting denial prevention through accurate front-end workflows. Clinical nursing background strengthens clinical documentation review and interpretation of medical-necessity criteria.

Prior Authorization & Insurance Verification Specialist (Independent Contractor) at Flora Verity Revenue Cycle Support (2018 – Present)

• Process prior authorization requests for medications, procedures, imaging, DME, and specialty services across commercial, Medicare, and Medicaid plans using CoverMyMeds, Availity, payer portals, and EHR authorization workflows.
• Verify insurance eligibility, benefits, referral requirements, and patient financial responsibility prior to scheduled services, reducing risk of claim denial.
• Research payer-specific authorization criteria, medical necessity guidelines, coverage limitations, documentation requirements, and submission pathways across commercial, Medicare, and Medicaid plans, translating payer requirements into actionable authorization workflows.
• Review clinical documentation for medical necessity and completeness, coordinating with providers to obtain additional information and minimize treatment delays.
• Communicate with payers, providers, schedulers, and billing staff to resolve authorization questions, clarify requirements, and expedite approvals.
• Document authorization decisions, reference numbers, approval dates, payer requirements, and follow-up actions accurately within EHR and tracking systems.
• Navigate Epic, Cerner, and Athena to review patient demographics, clinical documentation, and authorization status in support of patient access and revenue cycle workflows.
• Apply HIPAA-compliant remote workflows with consistent accuracy and timely follow-up.