Elias Rodriguez
Glendale,AZ
Summary
Results-driven healthcare professional with 6+ years of experience in medical claims processing, authorization management, adjudication, and denial resolution across physician, hospital, and DME services. Proven expertise in researching discrepancies, verifying eligibility and authorizations, reviewing EOBs, and processing adjustments in compliance with payer policies. Recognized for maintaining 100% audit compliance and consistently exceeding productivity metrics in remote environments. Demonstrates strong problem-solving abilities, adaptability, and attention to detail, with a focus on driving operational efficiency and achieving organizational goals.
Overview
9
9
years of professional experience
Work History
Authorization Specialist II
Centene Corporation (Arizona Complete Health)
Phoenix, AZ
10.2025 - Current
- Manage prior authorization requests, ensuring compliance with contractual turnaround times
- Support utilization management team with tracking, documentation, and case coordination
- Research and compile clinical information to support medical necessity review
- Verify member eligibility, coverage, and benefits using system tools
- Maintain accurate data entry within utilization management platforms
- Route cases to clinical reviewers and ensure proper workflow progression
- Ensure compliance with organizational policies and regulatory requirements
- Collaborate with internal teams to improve access to care and processing efficiency
Claims Analyst
Centene Corporation
Tempe, AZ
01.2018 - 12.2023
- Reviewed, researched, and processed claims for physician, hospital, and DME services.
- Researched discrepancies, verified coding and prior authorizations, and adjudicated claims for payment.
- Resolved denials, credit balances, COB, and high-dollar claims, reducing AR and ensuring accurate reimbursement.
- Analyzed claim trends and supported reporting to identify error patterns and process improvements.
- Maintained 100% audit compliance while consistently exceeding productivity and quality standards.
- Served as a resource for policy interpretation and claim adjudication guidance to peers.
Business Support Analyst
The Wood Master
Phoenix, AZ
03.2020 - Current
- Coordinate scheduling, material deliveries, and job site logistics to ensure efficient project workflows and on-time completion.
- Streamline daily operations by tracking tasks, prioritize workloads, and independently manage multiple projects simultaneously.
- Prepare, inspect, and approve surfaces to uphold strict quality, safety, and regulatory requirements.
- Communicate with clients to set expectations, provide progress updates, and confirm satisfaction.
- Mix and apply custom stains, topcoats, and finishes with precision, ensuring alignment with client specifications.
- Maintain inventory and supply chain record, monitor usage trends and ensure OSHA/EPA compliance.
Administrative Data Entry Clerk
Barr Credit Services
Tucson, AZ
06.2017 - 12.2017
- Completed insurance and financial data entry tasks with accuracy and efficiency.
- Followed established procedures to enter and process data correctly.
- Organized, sorted, and checked input data against original documents.
- Scanned documents and saved in database to keep records of essential organizational information.
Central Receiving Clerk
Walmart Distribution Center
Casa Grande, AZ
04.2017 - 06.2017
- Verified shipments and resolved discrepancies
- Reviewed invoices and ensured order accuracy
- Organized inventory and supported warehouse operations
Education
Associate of Business -
Central Arizona College
Coolidge, AZ05-2016
Certified Professional Coder – Apprentice (CPC-A) - Pending
AAPC
Medical Coding and Billing Certificate -
U.S. Career Institute
Fort Collins, CO03-2025
High School Diploma - undefined
Casa Grande Union High School
Casa Grande, AZ05-2011
Skills
- Prior Authorization & Utilization Management
- Medical Claims Processing & Adjudication
- Insurance Eligibility Verification
- Denial Resolution & Appeals
- Medical Terminology (ICD-10, CPT, HCPCS)
- UB-04/HCFA-1500 Forms
- EOB Review & Payment Reconciliation
- Referral & Authorization Tracking
- EHR Systems & Multi-System Navigation
- HIPAA Compliance & Regulatory Standards
- Data Entry Accuracy & Documentation
- Cross-Functional Collaboration
- Time Management & Remote Productivity
Languages
Spanish
Native or Bilingual
Timeline
Authorization Specialist II
Centene Corporation (Arizona Complete Health)
10.2025 - Current
Business Support Analyst
The Wood Master
03.2020 - Current
Claims Analyst
Centene Corporation
01.2018 - 12.2023
Administrative Data Entry Clerk
Barr Credit Services
06.2017 - 12.2017
Central Receiving Clerk
Walmart Distribution Center
04.2017 - 06.2017
High School Diploma - undefined
Casa Grande Union High School
Associate of Business -
Central Arizona College
Certified Professional Coder – Apprentice (CPC-A) - Pending
AAPC
Medical Coding and Billing Certificate -
U.S. Career Institute