Isuri Nagahawatta

Coordinate patient access for spinal cord stimulation (SCS), dorsal root ganglion (DRG), and peripheral nerve stimulation (PNS) therapies from consultation through post-procedure follow-up.

• Manage insurance verification, benefits investigations, and prior authorization processes for advanced neuromodulation procedures.

• Develop and support Letters of Medical Necessity utilizing clinical documentation and evidence-based treatment criteria to support payer approval requests.

• Partner with physicians during peer-to-peer reviews to address payer objections, communicate medical necessity, and advocate for appropriate patient access to care.

• Assist with appeals and denial management activities, contributing to successful overturns of coverage denials through comprehensive clinical and payer-specific documentation.

• Interpret payer policies and coverage requirements to guide providers and patients through complex reimbursement pathways.

• Collaborate with physicians, clinical staff, and insurance carriers to resolve authorization barriers and expedite treatment access.

• Educate patients and providers regarding insurance requirements, authorization processes, treatment pathways, and coverage expectations.

• Monitor authorization status and communicate updates to providers, patients, and internal stakeholders.

• Maintain detailed documentation of authorization outcomes, payer communications, and patient access activities.

• Supervised onboarding and training of new personnel to maximize capacities of team.
• Maintained and revised policy procedures for general operation of compliance program.
• Performed Quality Control and Quality Assurance Procedures
• Delegated daily tasks to team members to optimize group productivity.
• Utilized Microsoft Teams and spreadsheets to compile data.
• Recommended improvements to systems and procedures for increased productivity.
• Increased operations efficiency through execution of improvement processes.
• Established or maintained cooperative relationships with physicians from multiple departments.
• Optimized laboratory by applying protocols and procedures consistently in accordance with regulations and workplace health and safety requirements.
• Managed physical and digital files, monitored spreadsheets and updated reports to coordinate projects.
• Pulled patient records and transferred information to appropriate parties.
• Conducted staff performance evaluations to monitor progress and individual skills.
• Assisted with team building initiatives and overall support for maintenance of organizational culture and employee morale.
• Served as a resource for staff regarding insurance, patient access, and healthcare operations workflows.
• Trained and mentored employees on compliance, documentation standards, and operational best practices.
• Analyzed workflow trends and implemented process improvements that enhanced operational efficiency and customer experience.
• Collaborated with physicians and healthcare leaders to address operational and patient access challenges.