Jennifer Serrano Fabian
Haines city,FL
Summary
Prior Authorization Specialist with extensive experience at PMRG Remote, adept at navigating complex insurance processes and enhancing patient satisfaction. Proven track record in medical appeals handling and effective communication, ensuring timely authorizations and compliance with regulations. Skilled in data entry and insurance verification, consistently exceeding performance expectations.
Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 5 + years of managing documentation. Considered team player with exemplary multitasking skills.
Amiable Prior Authorization Representative with 5 + years of connecting patients and healthcare providers to vital resources. Dedicated to executing on prescribed medical funding guidelines and policies. Maintains compassionate and sympathetic relations with consumers. Adept at balancing business interests with human-centric service models. Healthcare professional prepared for role with strong background in managing prior authorizations and fostering positive relationships with healthcare providers and insurance companies. Known for collaborative approach and consistently achieving results despite changing needs. Proficient in medical coding, insurance guidelines, and effective communication.
Overview
13
13
years of professional experience
Work History
Prior Authorization Specialist
PMRG Remote
08.2019 - 09.2025
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Tracked referral submission during facilitation of prior authorization issuance.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
Payment Posting Specialist , Documentation Special
Virtual Royal
05.2016 - 07.2019
- Maintained strict compliance with HIPAA, CMS, and payer-specific guidelines during payment posting activities.
- Identified trends in payer denials and collaborated with other departments to resolve recurring issues proactively.
- Expedited month-end close procedures through efficient coordination with billing and finance teams.
- Contributed to improved patient satisfaction by promptly addressing inquiries related to their payments or account balances.
- Displayed adaptability by staying current with industry regulations and payer-specific policies, ensuring compliance in all payment posting activities.
- Collaborated closely with coding specialists for accurate charge capture, enabling timely and complete reimbursement from payers.
- Supported the transition to a new practice management system by providing input on payment posting workflows and functionalities based on expertise.
- Ensured timely reimbursement through meticulous claims adjustments and denials management.
- Improved payment processing efficiency by implementing automated posting systems.
- Served as a subject matter expert on payer contracts, fee schedules, and reimbursement methodologies for the team.
- Ensured HIPAA compliance with diligent attention to patient confidentiality in handling sensitive information.
- Facilitated communication between healthcare providers by transcribing consult notes, referral letters, and discharge summaries.
- Contributed to quality improvement initiatives by participating in regular audits of transcribed documents for accuracy and consistency.
- Enhanced physician efficiency by providing timely and accurate transcriptions for medical records.
- Expedited insurance claim processing by preparing comprehensive medical summaries for patients'' claims.
- Streamlined healthcare workflows by collaborating closely with interdisciplinary teams of physicians, nurses, and other specialists.
- Supported diagnostic processes by meticulously documenting test results and physician interpretations in the medical record.
- Verified accuracy of accounts payable payments, resulting in 50% reduction in payment errors and check reissues.
Insurance Verification Specialist
Response Answering Service
09.2012 - 04.2016
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Increased patient satisfaction by promptly addressing concerns regarding insurance coverage or billing issues.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Answered phone calls and messages , scheduling appointments, and handling patient inquiries.
Education
High School Diploma -
Leto High School
Tampa, FLSkills
- Prior authorization process
- Medical appeals handling
- Insurance verification
- Authorizations
- Data entry
- Medical office procedures
- Billing procedures
- Insurance procedures
- Retro-authorizations
- Pharmacy benefit management
- Patient scheduling
- Claims processing experience
- Claim research
- Utilization review experience
Languages
English
Full Professional
Spanish
Professional Working
Timeline
Prior Authorization Specialist
PMRG Remote
08.2019 - 09.2025
Payment Posting Specialist , Documentation Special
Virtual Royal
05.2016 - 07.2019
Insurance Verification Specialist
Response Answering Service
09.2012 - 04.2016
High School Diploma -
Leto High School
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