Healthcare,Insurance Expertise and Customer Senior Associate

With experience in healthcare customer service, insurance verification, and virtual assistance. Skilled in managing high‑volume email correspondence with supervisors, co‑teams, centers, and facilities, ensuring timely, accurate, and professional communication. Adept at resolving inquiries, coordinating with pharmacies, and supporting patients with empathy and efficiency.

Healthcare Customer Service & Claims Specialist with hands‑on experience in U.S. healthcare operations, including Centers for Medicare & Medicaid Services (CMS) and Lincare. Skilled in guiding patients, verifying insurance coverage, processing prescriptions, and coordinating with payors to ensure compliance and accurate documentation.

Experienced in reviewing and applying ICD‑10 ,Diagnosis Code,HCPC Code and CPT codes to ensure accurate insurance verification, claims processing, and prior authorization. Skilled in cross‑checking diagnosis and procedure codes for billing compliance, reducing claim denials, and supporting healthcare providers with precise documentation.

Handled inbound calls regarding healthcare benefits, eligibility, claims, coverage, and prescription inquiries. Assisted members with prior authorization requirements and prescription medication coverage. Verified insurance eligibility, benefits, copays, deductibles, coinsurance, and coverage limitations. Researched and resolved claim issues, denials, and member concerns. Educated members regarding healthcare benefits, plan coverage, and authorization requirements. Documented member interactions accurately while maintaining HIPAA compliance. Collaborated with providers, pharmacies, and internal departments to resolve complex inquiries.

Healthcare Customer Service & Insurance Verification Specialist with extensive experience assisting patients, providers, and pharmacies in navigating medical insurance processes. Skilled in verifying benefits, processing prior authorizations, and coordinating with payors to ensure accurate claims and seamless care delivery.

Experienced Customer Service Specialist with 4+ years of expertise in healthcare support, insurance verification, and patient communication. Skilled in handling inbound and outbound calls, resolving client concerns, and ensuring satisfaction through empathy, accuracy, and professionalism. I bring strong problem‑solving abilities and a proactive approach to every interaction, helping businesses deliver exceptional service and build lasting client relationships.

Verify patient insurance eligibility, benefits, coverage, deductibles, copays, and authorization requirements using Availity, Waystar, and payer portals. Process prior authorizations and authorization renewals through Availity, Carelon, Cohere,Quantum, Ambetter,Valer, Healthlink, BCBS, and other insurance payers Monitor expiring authorizations and initiate renewal requests to prevent interruptions in patient care. Communicate regulary via email with supervisors,local centers on-shore teams to ensure smooth operations and timely updates. Prepare and fax prescription and supply renewal forms to physician offices for review and signature. Follow up with providers to obtain signed prescriptions and required clinical documentation. Investigate denied, rejected, expired, or incomplete authorizations and prescriptions. Conduct inbound and outbound calls with patients, providers, physician offices, pharmacies, and insurance companies. Collect additional patient information required for insurance verification, authorizations, and prescription processing. Maintain accurate documentation while ensuring HIPAA compliance and payer guideline adherence.

Claims Submission: Prepared and submitted claims for Medicare, supplemental, and commercial insurance plans with a high first‑submission acceptance rate. Denials Management: Monitored claim status, identified rejections, and followed up with insurers to resolve issues quickly. Prior Authorization Integration: Ensured claims were supported by proper ICD‑10 and CPT coding and completed prior authorization approvals. Payment Posting & AR Follow‑Up: Recorded payments, reconciled accounts, and managed outstanding balances. Portal Expertise: Experienced with Availity and other insurance portals for claim tracking and verification. Compliance: Maintained accuracy and adherence to HIPAA, CMS, and insurance guidelines.

Patient Communication: Handled inbound and outbound calls, addressing patient inquiries with empathy and professionalism. Care Coordination: Assisted patients with scheduling, prescription requests, and insurance verification to ensure timely access to care. Insurance Guidance: Explained coverage, deductibles, co‑pays, and prior authorization requirements clearly to patients and families. Documentation Accuracy: Maintained precise patient records and ensured compliance with HIPAA and healthcare standards. Supportive Approach: Guided patients through claims, billing, and pharmacy coordination, reducing stress and improving satisfaction.

Prior Authorization Specialist | Availity, ICD‑10/CPT, Insurance Verification Healthcare VA | Prior Authorization, Insurance Verification & Claims Support Medical Insurance & Prior Authorization Expert | Payor Coordination & Patient Support

Ensure full compliance with HIPAA regulations and all company policies.