Carmen Rosario
Sanford,FL
Summary
Accomplished Prior Authorization Specialist skilled in navigating complex insurance policies and maintaining regulatory compliance. Expertise in patient education and interdepartmental collaboration to ensure accurate documentation and efficient claims resolution.
Overview
16
16
years of professional experience
Work History
Prior Authorization Specialist
CCS Medical
Clearwater, FL
09.2020 - Current
- Processed prior authorization requests for medical equipment and supplies, ensuring timely approvals for patient access.
- Collaborated with healthcare providers to collect essential documentation promptly.
- Communicated authorization status and next steps effectively to patients.
- Coordinated with departments to gather comprehensive information for prior authorizations, enhancing approval rates.
- Contacted insurance carriers to secure authorization notifications and pre-certifications.
- Identified reasons for denied claims and collaborated with insurance carriers to resolve issues, facilitating successful appeals.
Insurance Verifier
Alliance RX
Orlando, Florida
12.2018 - 08.2020
- Maintained detailed records of patient interactions and insurance verifications to ensure accurate billing.
- Collaborated with billing department to efficiently resolve claims discrepancies, ensuring timely reimbursements.
- Educated patients on insurance benefits and available coverage options.
- Utilized electronic health record systems to enhance verification workflows.
- Submitted prior authorization requests to insurance companies.
- Addressed patient inquiries regarding benefits and payment plans, enhancing patient understanding and satisfaction.
Insurance Verification Specialist
BioPlus Specialty Pharmacy
Altamonte Springs, Florida
04.2015 - 11.2018
- Utilized pharmacy management software to track and streamline verification processes.
- Verified patient insurance coverage before scheduling procedures or appointments.
- Assisted team members in navigating complex insurance policies to enhance efficiency.
- Called insurance companies to gather critical information on payment benefits and policies for accurate patient coverage.
- Entered data into EMR database to ensure accurate documentation of payer authorization requirements and coverage limitations.
- Navigated multiple online systems to obtain necessary documentation for approvals.
Pharmacy Technician
Oasis
St. Petersburg, Florida
08.2010 - 03.2015
- Accurately filled prescriptions for diverse patient needs in a timely manner.
- Prepared medications by counting, pouring, labeling, and verifying doses for dispensing.
- Collaborated with peers and pharmacists to prioritize and fulfill prescription orders effectively.
- Managed inventory to ensure optimal medication availability and organization.
- Performed data entry for patient profiles, billing details, and prescription orders in pharmacy software.
- Resolved customer complaints to maintain high service quality and patient satisfaction.
Education
High School Diploma -
Lakewood High School
Lakewood, NJSkills
- Insurance verification and prior authorization
- Medical documentation and claims resolution
- Coverage analysis and patient education
- Regulatory compliance
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Prior Authorization Specialist
CCS Medical
09.2020 - Current
Insurance Verifier
Alliance RX
12.2018 - 08.2020
Insurance Verification Specialist
BioPlus Specialty Pharmacy
04.2015 - 11.2018
Pharmacy Technician
Oasis
08.2010 - 03.2015
High School Diploma -
Lakewood High School