Gembee Policarpio
Killeen
Summary
Dynamic healthcare revenue cycle professional with over five years of experience specializing in prior authorizations, insurance verification, appeals, and payer issue resolution. Trusted leader known for building and guiding high-performing teams while driving automation solutions that transform workflow efficiency and accuracy. Brings deep expertise in clinical documentation review, cross-functional collaboration, and resolving complex authorization barriers, supported by strong process improvement through SOP development, matrix management, and KPI tracking.
Overview
9
9
years of professional experience
Work History
Lead Insurance Coordinator - Prior Authorization and Appeals
Autism Learning Partners
Killeen
2024.09 - Current
- Manage prior authorization requests across commercial and government payers.
- Process Single Case Agreements (SCAs) when services require out-of-network authorization.
- Coordinate appeals and denial resolution by compiling documentation and preparing medical necessity submissions.
- Review medical records and treatment documentation to ensure payer authorization requirements are met.
- Collaborate with providers, clinical teams, and revenue cycle leadership to support timely access to care.
- Resolve complex insurance escalations and communicate with payer utilization management departments.
- Analyze payer trends and authorization patterns to help reduce denials and improve workflow efficiency.
- Develop and maintain SOPs, internal guidelines, and workflow documentation for authorization processes.
- Build and monitor KPI dashboards to track productivity, turnaround times, and payer approval performance.
- Trained newly hired top talent to fill key positions and maximize productivity.
- Developed and maintained automation scripts using industry-standard tools and technologies.
Benefit Verification Specialist / Data Intake
Greenlight - Cencora Project
2023.10 - 2024.09
- Verified patient insurance eligibility, benefits, and coverage details across commercial and government plans.
- Performed data intake and reviewed incoming information for accuracy and completeness before processing.
- Communicated with internal teams, providers, and payers regarding benefit details and documentation needs.
- Supported timely case progression by identifying missing information and resolving intake discrepancies.
- Communicated effectively with healthcare providers to obtain necessary information.
Insurance Verification Specialist
Dimond Vision Clinic
2018.01 - 2019.09
- Handled insurance verification and authorization support for ophthalmology services.
- Reviewed documentation and coordinated with providers to obtain required payer approvals.
- Maintained communication with payer utilization management departments regarding authorization status.
- Verified insurance coverage for patients receiving eye care services.
Referral Management Specialist
Prairie Quest / JBER Hospital
2017.01 - 2018.01
- Supported referral management, insurance verification, and patient intake processes.
- Coordinated patient records and documentation while maintaining privacy and compliance standards.
- Assisted with administrative healthcare operations and scheduling support.
Skills
- Revenue Cycle Automation & Workflow Design
- Process Optimization & Scalable Operations
- KPI Development, Dashboarding & Performance Analytics
- SOP Development & Process Standardization
- Prior Authorization Strategy & Management
- Appeals, Denials & Complex Case Resolution
- Insurance Eligibility & Benefit Analysis
- Clinical Documentation Review & Medical Necessity Validation
- Payer Relations & Utilization Management Communication
- Cross-Functional Leadership, Training & Team Development
Personal Information
Title: Lead Insurance Coordinator | Prior Authorization and Appeals
Timeline
Lead Insurance Coordinator - Prior Authorization and Appeals
Autism Learning Partners
2024.09 - Current
Benefit Verification Specialist / Data Intake
Greenlight - Cencora Project
2023.10 - 2024.09
Insurance Verification Specialist
Dimond Vision Clinic
2018.01 - 2019.09
Referral Management Specialist
Prairie Quest / JBER Hospital
2017.01 - 2018.01