Loren Jackson
Minneola
Summary
Insurance professional with strong background in verifying insurance coverage and benefits. Skilled in navigating complex systems, resolving discrepancies, and ensuring accurate information. Known for excellent team collaboration and adaptability to changing needs. Efficient in communication, problem-solving, and maintaining high standards for quality and results. Extensive knowledge of CPT/ICD-10 coding, payer requirements, benefits verification, and authorization workflows. Proven ability to secure timely approvals, reduce treatment delays, and ensure compliance with HIPAA, Medicare, and Medicaid guidelines. Recognized for accuracy, efficiency, and strong communication with providers, payers, and patients.
Overview
11
11
years of professional experience
Work History
Insurance Verification Specialist
SCL Health
Colorado
12.2021 - Current
- Verify CPT codes to determine prior authorization requirements based on payer guidelines
- Validate active insurance coverage and confirm accurate ICD-10 coding prior to procedures
- Initiate, track, and follow up on prior authorizations to prevent interruptions in patient care
- Communicate with insurance carriers and provider offices to resolve authorization and benefits issues
Patient Access Coordinator
Kroger Specialty Pharmacy
Orlando, FL
10.2020 - 11.2021
- Conduct insurance verification for pharmacy and medical benefits for specialty medications
- Obtain and monitor prior authorizations and appeals, ensuring timely payer responses
- Activate copay assistance programs based on eligibility and prescribed therapies
- Provide ongoing patient updates regarding authorization status and coverage outcomes
Insurance Verification Specialist
Prime Therapeutics / AllianceRx Walgreens Prime
Orlando, FL
12.2014 - 08.2020
- Verified insurance eligibility, copays, deductibles, and out-of-pocket limits
- Initiated and followed through prior authorizations to ensure continuity of therapy
- Processed specialty medication claims including Humira, Harvoni, Tecfidera, Ampyra, Aveed, and others
- Applied BCBS Federal Employee Program (FEP) guidelines to claims and authorization workflows
Education
High School Diploma -
Almega Prep
Orlando, FL05-2004
Skills
- Insurance Verification & Benefits Investigation
- Prior Authorizations & Appeals
- CPT, ICD-10 & Medical Terminology
- Medicare, Medicaid & Commercial Payers
- HIPAA Compliance
- Specialty Pharmacy Support
- Claim Issue Resolution
- Documentation & Data Accuracy
Timeline
Insurance Verification Specialist
SCL Health
12.2021 - Current
Patient Access Coordinator
Kroger Specialty Pharmacy
10.2020 - 11.2021
Insurance Verification Specialist
Prime Therapeutics / AllianceRx Walgreens Prime
12.2014 - 08.2020
High School Diploma -
Almega Prep