BYRON K. HOLT JR.
Remote Healthcare Operations
Houston
Summary
Detail-oriented healthcare operations professional with 5+ years of experience supporting medical billing, claims resolution, prior authorizations, and pharmacy benefit workflows within payer and provider environments. Proven ability to navigate complex healthcare systems, ensure HIPAA compliance, and deliver high-accuracy documentation in fast-paced, KPI-driven settings. Strong background in back-office, non-phone work including claims review, eligibility verification, and utilization support. Known for exceptional attention to detail, process improvement, and cross-functional collaboration.
Overview
7
7
years of professional experience
Work History
Healthcare Customer Operations Specialist
OPTIMAL HOME HEALTH & STAFFING
04.2025 - 11.2025
- Supported back-office healthcare operations including insurance eligibility verification, claims follow-ups, and prior authorization documentation.
- Reviewed and documented patient and plan data across multiple systems to ensure accuracy and compliance.
- Coordinated with pharmacies, providers, and health plans to resolve medication access and benefit issues.
- Maintained strict HIPAA compliance while handling sensitive PHI and clinical documentation.
- Utilized CRM, EHR, RxClaims, Navinet, and Salesforce to track case status and ensure timely resolution.
- Consistently met productivity, quality, and accuracy KPIs in a high-volume environment.
- Remote
Administrative & Customer Support Associate
FLAWLESS HAIR & BEAUTY BAR
09.2024 - 04.2025
- Managed data entry, order processing, and customer communications via email and web platforms.
- Updated website content and maintained accurate product information.
- Coordinated fulfillment logistics and vendor communications.
Healthcare Operations Representative
AETNA MEDICARE (CVS HEALTH)
05.2022 - 07.2024
- Processed Medicare member benefit inquiries with a strong focus on claims, coverage rules, and documentation accuracy.
- Reviewed eligibility, benefits, copays, and authorization requirements for medical and pharmacy services.
- Escalated complex claims and authorization issues to appropriate departments for resolution.
- Ensured all case notes and updates met compliance and audit standards.
- Identified workflow improvements to enhance efficiency and member outcomes.
- Remote
Healthcare Support Specialist
UNITEDHEALTHCARE
09.2021 - 03.2022
- Assisted with claims research, prescription inquiries, and benefit clarification.
- Documented interactions and resolutions in enterprise systems with a strong emphasis on accuracy.
- Adhered to HIPAA and internal compliance standards at all times.
- Remote
Nondestructive Inspection (NDI) Inspector
NAVAIR
09.2018 - 10.2019
- Conducted detailed inspections and documented findings in electronic databases.
- Ensured compliance with military specifications and quality standards.
- Demonstrated exceptional attention to detail and audit-ready documentation practices.
Education
Associate in Quality Control - Non-Destructive Testing
Spartan College of Aeronautics And Technology
Tulsa, OK 05.2001 -
Skills
- Medical Billing & Revenue Cycle Support
- Claims Processing & Resolution
- Prior Authorizations & Utilization Management
- Pharmacy Benefits & Medication Access
- Medicare, Medicaid & Commercial Plans
Accomplishments
- Achieved Dean’s List honors at Spartan College, demonstrating consistent academic excellence and discipline.
Timeline
Healthcare Customer Operations Specialist
OPTIMAL HOME HEALTH & STAFFING
04.2025 - 11.2025
Administrative & Customer Support Associate
FLAWLESS HAIR & BEAUTY BAR
09.2024 - 04.2025
Healthcare Operations Representative
AETNA MEDICARE (CVS HEALTH)
05.2022 - 07.2024
Healthcare Support Specialist
UNITEDHEALTHCARE
09.2021 - 03.2022
Nondestructive Inspection (NDI) Inspector
NAVAIR
09.2018 - 10.2019
Associate in Quality Control - Non-Destructive Testing
Spartan College of Aeronautics And Technology
05.2001 -