Experienced healthcare operations specialist with expertise in prior authorizations, utilization management, provider assistance, and medical record maintenance.
Overview
14
14
years of professional experience
Work History
Medical Records/Health Information Specialist
Ohio Health Care Plus
Remote
05.2020 - 11.2025
Reviewed and uploaded medical records and documentation using EHR systems
Ensured patient charts were properly documented
Verified documentation compliance with healthcare and HIPAA
Assisted with chart audits
Used Epic EHR for chart review and medical record management
Collaborated with healthcare teams to streamline electronic health record workflows.
Provider Services/ Pre Certification Specialist
Molina Healthcare
Columbus, OH
05.2018 - 03.2020
Supported provider offices and hospitals staff by verifying coverage for CPT codes and medical services
Conducted pre-certification reviews for newborn admissions and extended hospital stays
Coordinated authorization request related to maternal and neonatal care
Communicated coverage determinations and plan requirements to clinical staff
Assisted with documentation submission and follow-up to ensure compliance with payer guidelines
Prior Authorization/ Utilization Specialist
Express Scripts
Dublin, OH
02.2012 - 04.2018
Processed Traditional and Step Therapy prior authorization via fax
Reviewed patient medical records and clinical documentation to determine coverage and medical necessity
Built and maintained authorization cases using faxed and electronic records
Identified missing and or incomplete documentation
Maintained strict compliance with HIPAA and internal healthcare guidelines
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