Debbie Alejos

Initial point of contact for Prior Authorization requests from members, providers, pharmacy's. Responsible for maintaining complete, timely and accurate documentation of all approvals and denials. Representative will determine if a complex call should be transferred to a pharmacist or other technician for assistance. Ability to pronounce Diagnoses and recognize medical terminology. As well as navigating multiple software systems to document conversations and outcomes that require keyboarding skills.

• Responded to inquiries from healthcare providers regarding prior authorization requests.
• Input all patient data regarding claims and prior authorizations into system accurately.
• Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
• Analyzed medical records and other documents to determine approval of requests for authorization.
• Assist member's with locating an in network Dentist

• Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
• Answered customer telephone calls promptly to avoid on-hold wait times.
• Offered advice and assistance to customers, paying attention to special needs or wants.
• Assisted with monthly invoices and discrepancies in paid claims and rejections.
• Walked users through accessing software and registration process.
• Assisted clients with reprocessing of rejected claims.