Cynthia Chavez
Avondale,AZ
Summary
Detail-oriented healthcare professional experienced in prior authorizations, insurance verification, and clinical documentation review. Committed to enhancing patient care through expertise in payer guidelines and authorization workflows in remote settings.
Overview
1
1
Language
19
19
years of professional experience
Work History
Authorization Specialist
Community Health Systems
10.2022 - 07.2026
- Reviewed provider documentation, chart notes, prior imaging results, and medical records, to verify clinical criteria, establish medical necessity and support prior authorization approvals.
- Requested and obtained prior authorizations for diagnostic imaging, including echocardiograms, PET scans, MRIs, stress tests, CTs, and CTAs through phone, fax and payer portals.
- Tracked authorization submissions, approvals, pending requests, and denials, ensuring accurate records within electronic health systems to support efficient processing.
- Reviewed authorization denial reasons, identified missing or insufficient documentation, and submitted additional clinical information to secure approvals.
- Managed high-volume caseload while ensuring quality standards met productivity benchmarks, contributing to timely authorization processes.
- Worked with clinical, scheduling, and verification teams to secure authorizations before services were provided.
Registered Medical Assistant
Phoenix Children's Hospital
Phoenix, Arizona
02.2021 - 05.2022
- Performed patient assessments, including vital signs and medical history documentation.
- Maintained accurate patient records in compliance with HIPAA regulations.
- Executed provider instructions for pharmacy refills, lab result tracking, and medical record management.
- Completed high volumes of prior authorizations efficiently.
- Requested and obtained prior authorizations via phone, electronic systems, fax, and payer portals.
- Verified insurance coverage and processed payments from patients.
- Demonstrated empathy and professionalism through phone, video, email, Slack, text, and patient portal communications.
- Responded promptly to patient messages and left clear voice mail instructions.
- Coordinated with medical facilities to schedule patients for admission.
Medical Assistant
JFCS Glendale Health Center
02.2014 - 12.2020
- Assisted physicians with patient care by taking vital signs, patient histories and preparing patients for examinations.
- Conducted EKGs, spirometry testing, audiograms and other diagnostic tests as requested by the physician.
- Completed intake, collecting and documenting patient demographics, medical history, current medications, allergies, presenting concerns and other clinical information.
- Verified patient eligibility, benefits, formulary requirements, coverage limitations, and prior authorization criteria for prescription and specialty medications.
- Called insurance companies and pharmacy benefit managers via phone, fax, and payer portals to initiate, follow up, and resolve prior authorization requests and claims status.
- Maintained accurate patient information and insurance verification within electronic health record to support efficient clinical intake and prior authorization.
- Reviewed clinical documentation, orders, lab results, medication trials and treatment history to support medical necessity.
- Ensured all clinical documentation, authorization determinations, and insurance verifications were scanned into patients' chart within the EHR.
- Collaborated with healthcare team to streamline patient care processes and enhance overall quality of care.
Medical Assistant
The Childrens Doctor
Phoenix, Arizona
08.2007 - 02.2014
- Administered medications according to healthcare provider instructions.
- Educated patients on treatment plans and preventive care measures.
- Coordinated referral processing and patient intake, ensuring effective communication between patients and specialists for comprehensive care management.
- Verified patient eligibility, benefits, formulary requirements, coverage limitations, and prior authorization criteria for specialists, procedures, and specialty medications efficiently.
- Managed patient records and maintained confidentiality in all interactions.
- Adhered to HIPAA regulations regarding safeguarding confidential patient information at all times.
- Collaborated with clinical staff to resolve complex authorization issues.
Education
Medical Assistant Diploma -
Apollo College
Phoenix, AZHigh School Diploma -
Ronald C Bauer
Phoenix, AZSkills
- Prior Authorization
- Benefit Verification
- Insurance Verification
- Denial Management
- Medical Necessity
- Payer Guidelines
- Medical Terminology
- ICD-10
- CPT
- HCPCS codes
- Electronic Health Records
- EMR systems
- Payer Portals
- Documentation Accuracy
- Data Entry
- Scheduling
- Appointment Coordination
- Clinical Intake
- Care Coordination
- Remote Communication Tools
- Microsoft Outlook
- Excel
- PowerPoint
- Attention to Detail
- Time Management
- Organization
- Prioritization
- Adaptability
- Bilingual proficiency
- Patient management
- Appeals
- HIPAA Compliance
Languages
Spanish
Native/ Bilingual
Timeline
Authorization Specialist
Community Health Systems
10.2022 - 07.2026
Registered Medical Assistant
Phoenix Children's Hospital
02.2021 - 05.2022
Medical Assistant
JFCS Glendale Health Center
02.2014 - 12.2020
Medical Assistant
The Childrens Doctor
08.2007 - 02.2014
Medical Assistant Diploma -
Apollo College
High School Diploma -
Ronald C Bauer