Cecilia Smith
Temple Hills,USA
Summary
Detail-oriented and highly organized Prior Authorization Specialist with over 5 years of healthcare administrative and utilization management experience, including Medicare precertification in a remote environment. Proven ability to manage high-volume authorization requests, verify benefits, interpret payer policies, and coordinate approvals to ensure timely patient access to care. Strong knowledge of medical terminology, CPT/ICD-10 coding, and HIPAA compliance. Bilingual in English and Spanish with a patient-centered approach and excellent communication skills.
Overview
16
16
years of professional experience
Work History
Health Coordinator – UM Clinical / Precertification
Cigna Medicare
10.2022 - Current
- Receive and process prior authorization requests from hospitals, providers, members, and vendors via fax, phone, and online portals
- Determine authorization outcomes based on company policy, member benefit grids, provider status, and medical necessity guidelines
- Verify insurance eligibility and benefits for Medicare members
- Review, manage, and upload medical records to member accounts to support authorization decisions
- Prioritize authorization requests based on urgency, clinical need, and regulatory turnaround requirements
- Communicate authorization status and next steps to patients, physicians, and provider offices
- Maintain accurate documentation while ensuring strict HIPAA compliance in a remote setting
- Specialized in pre-procedure instructions in compliance with departmental and payer guidelines
- Entered and updated patient orders, demographics, and insurance information in EMR systems
- Performed annual insurance reverifications and obtained new authorizations as required
- Screened and reviewed inbound electronic prior authorization requests from pharmacies and providers
- Reviewed patient charts for labs, tests, and medical records needed to support authorization submissions
- Utilized CPT and ICD-10 codes to coordinate and communicate authorization needs
- Verified pharmacy benefits and processed prescription prior authorizations
- Collaborated with office staff, clinical teams, and managers to resolve authorization issues
Patient Care Coordinator
Capital Digestive Care
03.2021 - 07.2022
- Coordinated patient care from referral through start of treatment, ensuring completion of all authorization and documentation requirements
Receptionist / Front Office Coordinator
Capital Digestive Care
01.2018 - 02.2021
- Managed patient intake, scheduling, registration, and insurance verification
- Answered and routed high-volume inbound calls and messages
- Collected patient copayments and posted daily account balance updates
- Maintained and safeguarded medical records in compliance with HIPAA regulations
Career Break
Stay-at-Home Mother
06.2015 - 12.2017
Hemodialysis Technician
Fresenius Medical Care
06.2010 - 05.2015
- Monitored dialysis machines and ensured proper disinfection and equipment functionality
- Collected and recorded patient vital signs pre- and post-treatment
- Operated reverse osmosis water systems and completed required monitoring tests
- Accessed fistulas, grafts, and catheters following strict infection control protocols
- Managed inventory, ordering, and restocking of dialysis supplies
- Collected weekly and monthly treatment-related laboratory samples
Education
High School Diploma -
John F. Kennedy High School
Silver Spring, MD01.2008
Skills
- Prior Authorization & Precertification
- Utilization Management (UM)
- Medicare & Commercial Insurance
- Insurance Eligibility & Benefits Verification
- CPT / ICD-10 Coding
- Medical Records Review
- Appeals & Denial Prevention
- EHR / EMR Systems
- Remote Case Management
- HIPAA Compliance
- Provider & Patient Communication
- Bilingual: English & Spanish
- Microsoft Word & Excel
- Electronic Medical Records (EMR/EHR) Systems
- Insurance Portals & Fax Systems
Timeline
Health Coordinator – UM Clinical / Precertification
Cigna Medicare
10.2022 - Current
Patient Care Coordinator
Capital Digestive Care
03.2021 - 07.2022
Receptionist / Front Office Coordinator
Capital Digestive Care
01.2018 - 02.2021
Career Break
Stay-at-Home Mother
06.2015 - 12.2017
Hemodialysis Technician
Fresenius Medical Care
06.2010 - 05.2015
High School Diploma -
John F. Kennedy High School