Alexa Macaluso
Tampa,FL
Summary
Clinical Account Specialist adept at securing timely authorizations and optimizing operational workflows within healthcare environments. Proven track record in enhancing patient experiences and client satisfaction by leveraging extensive knowledge of insurance requirements and strategic communication.
Overview
13
13
years of professional experience
Work History
Prior Authorization Specialist- Senior
CND Life Sciences
Scottsdale, Arizona
05.2025 - Current
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Performed detailed medical reviews of prior authorization requests, following established criteria and protocols.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Notified ordering providers of denied authorizations.
- Provided customer service support by responding promptly to provider inquiries regarding authorization status or policy information.
- Assisted patients with inquiries regarding services, policies, and procedures.
- Collaborated with internal departments to provide account status updates.
- Communicated effectively both verbally and in writing with various levels of staff across the organization.
Patient Access Specialist- Senior
PRIA healthcare
Farmington, Connecticut
06.2024 - 05.2025
- Processed prior authorization requests, ensuring accuracy and timely approvals to enhance patient access to necessary services.
- Facilitated insurance verification and eligibility checks for patient accounts.
- Utilized online eligibility systems to confirm patient coverage under Medicare, Medicaid, and third-party payers.
- Coordinated issue resolutions and appealed denied authorizations, improving approval rates for patient services.
- Collaborated with healthcare providers to gather essential information, streamlining authorization submissions.
- Performed detailed medical reviews of prior authorization requests according to established guidelines.
- Analyzed denied claims to identify root causes, facilitating proactive resolutions and minimizing future denials.
- Assisted patients with financial counseling and payment options for services.
- Ensured accurate patient billing through meticulous coordination of insurance verification.
Prior Authorization Coordinator Team Lead
Florida Orthopedic Institute
Tampa, Florida
01.2022 - 05.2025
- Managed prior authorization requests for orthopedic procedures, ensuring compliance and timely approvals.
- Reviewed prior authorization requests for orthopedic procedures to ensure compliance.
- Coordinated communications between patients, physicians, and insurance providers to secure timely approvals.
- Resolved denial authorization requests by effectively communicating with stakeholders to achieve successful outcomes.
- Coordinated issue resolutions and appealed denials authorizations, securing approvals for patients.
- Scheduled peer-to-peer reviews for physicians to discuss medical necessity with insurance providers.
- Trained new staff on prior authorization procedures and best practices, improving team readiness.
- Updated reference materials with Medicare, Medicaid, and third-party payer guidelines to ensure compliance and accuracy.
- Maintained accurate records of authorization statuses and follow-ups.
- Maintained professionalism in interactions with external customers, including physicians' offices and insurers.
- Communicated effectively across various organizational levels, ensuring clarity and alignment.
Medical Office Manager
Buscemi Orthopedics
Tampa, Florida
01.2021 - 12.2021
- Oversaw daily operations of orthopedic practice, optimizing front desk efficiency and patient experience.
- Implemented strategies to streamline patient flows, enhancing operational efficiency and contributing to revenue growth.
- Ensured accuracy in billing processes and insurance claims, and enhanced cash flow.
- Managed accounts receivable to ensure timely payments from patients and insurers, supporting financial stability.
- Developed policies to streamline workflows and increase patient satisfaction.
- Trained administrative staff on office protocols, improving service delivery standards and patient satisfaction.
- Compiled weekly financial reports highlighting key performance indicators such as revenue and receivables.
- Resolved customer inquiries regarding appointments and billing issues, maintaining high-quality service.
Front Office Coordinator
WCMI ortho
Brooksville, FL
08.2018 - 12.2020
- Oversaw guest check-in and check-out operations to ensure adherence to service standards.
- Managed patient scheduling and effectively resolved conflicts to enhance service delivery.
- Trained new hires on procedures and customer service protocols.
- Facilitated meetings with front office staff to identify and implement actionable process improvements.
- Evaluated daily front desk operations to ensure optimal staffing and resource allocation.
- Scheduled staff shifts based on operational needs.
- Addressed patient inquiries promptly, maintaining professionalism.
- Developed performance evaluation criteria and recognition plans to boost employee engagement and morale.
Front Office Manager
Rehab Therapy Works
Brooksville, Florida
03.2014 - 08.2018
- Oversaw front office operations, managing guest greetings and communications to ensure positive experiences.
- Developed strategies to enhance guest satisfaction and streamline operations.
- Addressed customer complaints promptly while maintaining professionalism in all interactions.
- Reviewed daily occupancy and revenue reports to identify trends, guiding operational improvements.
- Designed employee schedules to ensure optimal shift coverage, supporting seamless front office operations.
- Facilitated meetings with staff to introduce new initiatives or discuss process enhancements.
- Performed administrative duties such as paperwork filing, report preparation, and database updates.
- Established partnerships with patients and healthcare providers to enhance care delivery.
Skills
- Authorization processing procedures
- Claims processing management
- Insurance claim management
- Eligibility verification processes
- Utilization review
- Appeals handling
- Peer-to-peer reviews
- Patient access coordination
- Provider communication strategies
Timeline
Prior Authorization Specialist- Senior
CND Life Sciences
05.2025 - Current
Patient Access Specialist- Senior
PRIA healthcare
06.2024 - 05.2025
Prior Authorization Coordinator Team Lead
Florida Orthopedic Institute
01.2022 - 05.2025
Medical Office Manager
Buscemi Orthopedics
01.2021 - 12.2021
Front Office Coordinator
WCMI ortho
08.2018 - 12.2020
Front Office Manager
Rehab Therapy Works
03.2014 - 08.2018