Danae Fuller
Paterson
Summary
Experienced Prior Authorization Specialist with 8 years of healthcare industry experience. Adept at navigating complex insurance verification and prior authorization processes. Proven ability to collaborate with cross-functional teams, optimize workflows, and maintain regulatory compliance. Thrives in dynamic environments, ready to contribute to innovative solutions at DrFirst by curating business rules and streamlining healthcare processes.
Overview
8
8
years of professional experience
Work History
Prior Authorization Specialist II
CarePathRx
10.2023 - Current
- Manage and submit medical records for preauthorization, ensuring compliance with insurance policies and optimizing claim approval processes
- Provide real-time updates to healthcare providers regarding pending authorizations while maintaining HIPAA compliance
- Spearhead training programs for new hires, ensuring they are well-versed in authorization processes and insurance benefit verification
- Collaborate with internal stakeholders to enhance software systems that streamline authorization workflows
Senior Eligibility Representative
Cigna/Accredo Specialty Pharmacy
10.2022 - 11.2023
- Established and maintained partnerships with key stakeholders, driving enhanced community engagement and improving customer service outcomes
- Monitored and refined outreach strategies, ensuring alignment with organizational goals and improving efficiency in resolving prior authorization cases
- Implemented initiatives to foster team accountability and deliver exceptional customer experience
Clinical Outreach Coordinator
UnitedHealthcare
08.2016 - 10.2022
- Developed and sustained relationships with community resources and service providers, enhancing patient access to essential healthcare services
- Streamlined internal workflows to deliver cost savings through vendor negotiations and effective inventory management
- Organized professional development workshops, ensuring smooth execution and participant satisfaction
Education
Bachelor Of Science -
Syracuse University
Syracuse, NYSkills
- Prior authorization process
- Medical terminology
- Medical appeals handling
- Insurance verification
Timeline
Prior Authorization Specialist II
CarePathRx
10.2023 - Current
Senior Eligibility Representative
Cigna/Accredo Specialty Pharmacy
10.2022 - 11.2023
Clinical Outreach Coordinator
UnitedHealthcare
08.2016 - 10.2022
Bachelor Of Science -
Syracuse University
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