Andrea Johnson
Garland,TX
Summary
Detail-oriented prior authorization specialist with expertise in medical claims processing and health insurance verification. Proficient in electronic health records and effective client communication, ensuring efficient tracking of authorization statuses. Demonstrated ability to streamline processes and enhance operational efficiency.
Overview
11
11
years of professional experience
Work History
Prior Authorization Specialist/Care Manager
Aetna
REMOTE, TX
01.2025 - Current
- Reviewed prior authorization requests for medical services and treatments.
- Collaborated with healthcare providers to collect essential patient information for authorization processes.
- Reviewed patient records to assess coverage eligibility under insurance policies.
- Leveraged electronic health record systems to monitor and update authorization statuses.
Case Manager/Claims Examiner/Prior Authorization Representative
United Healthcare Group
REMOTE, TX
03.2015 - 12.2024
- Analyzed policy coverage details to determine claim eligibility and benefits.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Processed medical claims efficiently using advanced claims management software.
- Communicated with clients regarding claim statuses and required documentation.
- Managed patient records using electronic health systems for accurate information tracking.
- Scheduled appointments and follow-ups to maintain consistent patient engagement in care processes.
Education
High School Diploma -
Penn Foster College
Scottsdale, AZ05-2025
Skills
- Authorization processes
- Claims processing
- Insurance verification
- Coverage analysis
- Electronic health records
- Client communication
Timeline
Prior Authorization Specialist/Care Manager
Aetna
01.2025 - Current
Case Manager/Claims Examiner/Prior Authorization Representative
United Healthcare Group
03.2015 - 12.2024
High School Diploma -
Penn Foster College