Carmen Rosario
Sanford,FL
Summary
Dynamic Prior Authorization Specialist with extensive experience at CCS Medical, adept at navigating complex insurance processes and enhancing provider relations. Proficient in medical terminology and effective communication, I excel in securing timely approvals and maintaining compliance with patient confidentiality, ensuring optimal patient care and satisfaction.
Overview
9
9
years of professional experience
Work History
Prior Authorization Specialist
CCS Medical
Clearwater, FL
09.2020 - Current
- Facilitated processing of prior authorization requests for medical services.
- Collaborated with healthcare providers to gather necessary documentation for approval.
- Coordinated responses to authorization and patient-related queries.
- Maintained accurate records of approvals and denials in electronic health systems.
- Communicated with healthcare providers and insurance companies to clarify documentation requirements.
Prior Authorization Specialist
Bio Plus Specialty Pharmacy
Altamonte Springs, FL
07.2016 - 08.2020
- Facilitated processing of prior authorization requests for medical services.
- Collaborated with healthcare providers to gather necessary documentation for approval.
- Coordinated responses to authorization and patient-related queries.
- Maintained accurate records of approvals and denials in electronic health systems.
- Communicated with healthcare providers and insurance companies to clarify documentation requirements.
Education
Bachelor Of Social Work - Marriage And Family Therapy
Liberty University
Lynchburg, VAHigh School Diploma - General Studies
Lakewood High School
Lakewood, NJ06.2003
Skills
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Insurance verification
- Effective communication skills
- Patient referrals
- Data entry
- Electronic health records proficiency
- Medical terminology knowledge
- Physician order verification
- Benefit coverage
- Medical office procedures
- Billing procedures
- Insurance procedures
- Workflow management
- Retro-authorizations
- Patient confidentiality compliance
- Records maintenance
- Provider relations
- Performance metrics analysis
- Authorizations
Languages
Spanish
Native or Bilingual
Timeline
Prior Authorization Specialist
CCS Medical
09.2020 - Current
Prior Authorization Specialist
Bio Plus Specialty Pharmacy
07.2016 - 08.2020
Bachelor Of Social Work - Marriage And Family Therapy
Liberty University
High School Diploma - General Studies
Lakewood High School