Summary
Overview
Work History
Education
Skills
Timeline
Generic

Emily Sullivan

Houston,TX

Summary

Healthcare operations specialist with 5+ years of experience supporting prior authorizations, claims investigations, appeals processing, and clinical workflows in remote payer and digital health environments. Proven ability to manage high case volumes, maintain audit-ready documentation, and collaborate with providers, payers, and PBMs to improve medication access and operational efficiency.

Overview

6
6
years of professional experience

Work History

Clinical Assistant

Vida Health
Houston, TX—Remote
06.2025 - Current
  • Manage 100+ weekly prior authorization cases for specialty medications including GLP-1 therapies.
  • Coordinate with PBMs, providers, and care teams to resolve medication access barriers.
  • Investigate denials and support clinical appeals documentation.

Provider Operations Specialist

Alma
Houston, TX—Remote
05.2024 - 06.2025
  • Resolved onboarding, credentialing, payment, and account-related issues within strict SLAs
  • Triaged 40+ tickets daily while maintaining detailed case documentation in Zendesk
  • Identified recurring workflow issues and escalated to product and engineering teams
  • Supported compliance reporting and audit readiness through accurate documentation
  • Delivered Tier 2 support for providers via chat and email in a high-volume SaaS environment

Claims Specialist

Aetna Medicare
Houston, TX—Remote
04.2022 - 05.2024
  • Processed Medicare claims, coverage inquiries, and prior authorization requests
  • Investigated complex billing disputes and compliance-related cases
  • Ensured adherence to CMS regulations and payer guidelines
  • Maintained audit-ready documentation in Salesforce and internal systems
  • Escalated high-risk compliance issues and supported resolution workflows

Billing Specialist

TridentCare
Houston, TX—Remote
01.2020 - 04.2022
  • Investigated 30+ billing accounts daily, processed appeals documentation, and resolved complex insurance claims issues.
  • Processed appeals documentation and payment corrections
  • Collaborated with insurance payers to resolve complex claims issues
    Ensured regulatory compliance and accurate case documentation

Education

Associate of Science - Paralegal Studies

Penn Foster
Houston, TX—Remote

Skills

  • Prior Authorizations (Medical & Pharmacy)
  • Appeals & Denials Resolution
  • Claims Investigation & Compliance
  • Insurance Eligibility & Verification
  • Care Coordination
  • Provider & PBM Collaboration
  • Salesforce
  • Zendesk
  • Availity
  • Epic EHR
  • Asana
  • Jira
  • Slack
  • Zoom
  • Google Workspace

Timeline

Clinical Assistant

Vida Health
06.2025 - Current

Provider Operations Specialist

Alma
05.2024 - 06.2025

Claims Specialist

Aetna Medicare
04.2022 - 05.2024

Billing Specialist

TridentCare
01.2020 - 04.2022

Associate of Science - Paralegal Studies

Penn Foster
Emily Sullivan