Belinda Fillmore
San Antonio,TX
Summary
Dynamic Care Management Associate and Claims Specialist with 24 years in healthcare administration, including 7 years of remote experience. Expertise includes prior authorization, insurance verification, HIPAA compliance, and process improvement to drive positive patient outcomes.
Overview
25
25
years of professional experience
Work History
Care Management Associate
Aetna, a CVS Health
05.2006 - 07.2025
- Expedited patient access to care by ensuring all insurance requirements (eligibility, benefits, and pre-authorizations) were met prior to service, leveraging the Epic EHR platform.
- Expedited patient access to care by ensuring all insurance requirements (eligibility, benefits, and pre-authorizations) were met prior to service, leveraging the Epic EHR platform.
- Applied medical terminology, ICD-10, and CPT coding knowledge to evaluate clinical documentation and support accurate prior authorization submissions and clinical justification.
- Forged cross-functional alliances with Utilization Management, Case Management, and clinical teams to proactively resolve complex authorization bottlenecks, accelerating patient care timelines, and reducing authorization time by 15%.
- Championed data integrity for authorization documentation across all communications and determinations within the EHR, providing reliable data for audits, quality metrics, and maintaining a 100% accuracy rate.
- Leveraged deep technical expertise to mentor 20 representatives, troubleshoot authorization systems, and implement strategic process changes that significantly accelerated operational efficiency.
- Streamlined the retrospective review process, resolving an average of 150 complex or denied claims per week, ensuring timely and accurate resubmission by addressing all underlying billing, coding discrepancies, and authorization status.
- Facilitated the submission and resolution of member and provider appeals, leveraging strong analytical skills to review complex cases and determine appropriate action.
Claims Benefit Specialist
Aetna, a CVS Health
11.2000 - 05.2006
- Analyzed and finalized a high volume of complex claims (250+ per week) using QNXT, Availity, and EPP systems, consistently surpassing quality metrics of 98% or higher, and ensuring full regulatory compliance.
- Maintained a 98% accuracy rate in claims processing by meticulously verifying patient eligibility, benefits, and authorization details.
- Utilized medical billing and coding knowledge to interpret CPT and ICD-10 codes for accurate claim processing.
- Maintained strict adherence to company procedures and regulatory requirements, facilitating prompt payment of approved claims.
Education
GED -
NISD Adult Education
San Antonio06.1995
Skills
- Salesforce
- Electronic Health Record
- EPIC
- Prior Authorization
- Medical Terminology
- Call Center
- Customer Service
- HIPPA
Timeline
Care Management Associate
Aetna, a CVS Health
05.2006 - 07.2025
Claims Benefit Specialist
Aetna, a CVS Health
11.2000 - 05.2006
GED -
NISD Adult Education