Healthcare Insurance Authorization Specialist
Negros Oriental
**HEALTHCARE AUTHORIZATION & INSURANCE VERIFICATION** *Turning Complex Insurance Processes into Approved Care* Detail-oriented Healthcare Administration Professional with 10+ years of experience in healthcare operations, insurance verification, prior authorization, and revenue cycle support. Proven ability to navigate complex payer requirements, secure approvals for specialized procedures, coordinate clinical documentation, and advocate for medical necessity through detailed appeals and Peer-to-Peer reviews. Highly experienced in working directly with insurance companies, providers, and clinical teams to move cases from verification and authorization to resolution and reimbursement. Skilled in payer portals, Availity, and leading EMR platforms including Athena, AdvancedMD, Tebra, and DrChrono. Known for being resourceful, persistent, and detail-oriented when resolving challenging authorization and insurance issues while keeping patient care and practice efficiency at the forefront.
Elite Vein Clinic, full_time
Aug 2020 to Jan 2026
Directed the full authorization process for specialized procedures, ensuring all clinical prerequisites were met prior to service. Actively initiated contact with insurance companies to verify benefit specific coverage and secure required authorizations. Served as a primary liaison for appeals, drafting reconsiderations for denied authorizations and facilitating Peer-to-Peer reviews between physicians and insurance medical directors. Managed practice Revenue Cycle by monitoring aging reports (AR) and resolving authorization-related payment delays.
WRS Health, full_time
Jun 2019 to Present
Managed patient eligibility and coverage updates, ensuring primary, secondary, and tertiary insurance data was accurate for seamless authorization. Utilized WRS EHR software to manage appointment scheduling and confirm patient data vital to the authorization process. Educated patients and providers on the importance of reputation management and practice efficiency
Teletech Holdings (Wellpoint West / Blue Cross), full_time
Oct 2011 to Dec 2014
Conducts comprehensive training classes for new hires, providing the specialized knowledge and skills required for the production floor. Attends training seminars to disseminate account updates and process changes to the agent team. Provides expert-level support on claims, eligibility, and authorization status for individual and facility providers. Handled inquiry tracking for claims and disputes sent for medical review to ensure timely processing. Processed and forwarded faxed medical records to support clinical review and claim adjudication.