Gellisa Crawford
Houston
Summary
Results-driven Clinical Authorization Specialist with expertise in navigating healthcare regulations and enhancing approval rates. Skilled in collaborating with healthcare providers to resolve discrepancies and improve patient care coordination, while maintaining a 96% first-pass approval rating.
Overview
7
7
years of professional experience
Work History
Clinical Authorization Specialist
Conifer Healthcare Solutions
Houston, TX ( Remote)
09.2025 - 08.2026
- Managed full-cycle prior authorizations for high-volume outpatient specialties, maintaining a 96% first-pass approval rating on complex prior-auth requests.
- Collaborated with healthcare providers to resolve authorization discrepancies and expedite approvals.
- Executed appeals for overturned authorization requests by drafting data-backed medical necessity arguments supported by peer-reviewed clinical data, improving chances of successful reinstatement.
- Analyzed clinical charts, diagnostic data, and physician notes to validate medical necessity against specific commercial and government payer guidelines.
- Reviewed insurance guidelines to identify key factors impacting approval rates for services rendered, enhancing compliance and streamlining processes.
- Processed authorization requests efficiently, ensuring compliance with healthcare regulations.
- Maintained accurate records in electronic health systems to streamline patient care coordination.
- Collaborated with clinical staff and physicians to extract missing diagnostic metrics, which reduced prior authorization turnaround times by 3 business days on average.
Health Concierge
Garner Health Technology
Houston, TX ( Remote)
02.2026 - 07.2026
- Engaged with 65+ members daily via phone, live chat, and email, guiding them through complex health plan structures and connecting them with optimal local providers.
- Assisted members in navigating healthcare options and resources efficiently.
- Coordinated communication between patients and healthcare providers to ensure effective care delivery.
- De-escalated and resolved complex member concerns regarding claim denials, deductibles, and out-of-pocket costs with high empathy and clarity
- Documented interactions and feedback to improve overall member experience and satisfaction.
- Leveraged comprehensive knowledge of health technology tools to enhance process efficiency.
- Collaborated closely with clinical and operations teams to escalate edge-case network eligibility issues, accelerating standard response turnaround times by 20%.
HIM Analysis
AdventHealth
Houston, TX (Remote)
05.2022 - 07.2024
- Cultivated respectful and friendly relationships while assisting team members.
- Supported day-to-day operations by collaborating effectively with all team members.
- Identified issues, analyzed information, and provided solutions to problems.
- Used critical thinking to break down problems, evaluate solutions, and make decisions.
- Adapted schedule to meet operational demands and ensure adequate coverage. across night, weekend, and holiday shifts.
- Goal-oriented professional with proven success in applying analytical skills to solve complex problems and overcome challenges. Dedicated to enhancing team performance and driving business success.
Medical Records Specialist
Ascension Health Care
Houston, TX (Remote)
11.2021 - 04.2022
- Ensured accuracy and completeness of medical documentation for compliance with regulations.
- Maintained patient records in compliance with security regulations.
- Organized and maintained patient records using electronic health record systems.
- Processed requests for medical records while safeguarding patient confidentiality.
- Collaborated with healthcare professionals to streamline documentation processes.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Supported the transition to updated electronic health record technologies, ensuring smooth implementation.
Epic Abstractor
Medasource
Houston. TX (Remote)
05.2019 - 01.2022
- Analyzed medical records to extract relevant data for accurate coding and billing processes.
- Ensured compliance with healthcare regulations by maintaining meticulous documentation standards.
- Collaborated with healthcare providers to clarify discrepancies in patient information and documentation.
- Trained junior staff on efficient data extraction techniques and best practices for abstracting medical records.
- Streamlined data collection procedures, enhancing overall efficiency in record abstraction tasks.
- Implemented process improvements that reduced turnaround time for record retrieval and abstraction tasks.
- Expedited the completion of critical projects by prioritizing tasks effectively and efficiently utilizing available resources.
Education
Bachelor of Science - Public Health
Monroe College
Bronx, NY04-2012
Skills
- Clinical Documentation
- ICD-10 Codes/ CPT
- EOBs and EFTs
- EPIC
- Data Management
- Networking
- Time Management
- Microsoft Software Proficiency
- Flexibility and adaptability
- Training & Development
- Customer service
- Phone communication
- Active listening
- VRM
- ROIS
Timeline
Health Concierge
Garner Health Technology
02.2026 - 07.2026
Clinical Authorization Specialist
Conifer Healthcare Solutions
09.2025 - 08.2026
HIM Analysis
AdventHealth
05.2022 - 07.2024
Medical Records Specialist
Ascension Health Care
11.2021 - 04.2022
Epic Abstractor
Medasource
05.2019 - 01.2022
Bachelor of Science - Public Health
Monroe College