LYNNE WASHINGTON
LAS VEGAS
Summary
Organized professional knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in the medical industry, communicating effectively orally and through writing and developing prior authorization workflows.
Overview
10
10
years of professional experience
Work History
Prior Authorization Determination Appeals Rep
SGS Consulting, Temporary Contract With CVS
Las Vegas, NV
10.2025 - 04.2026
- Managed appeals processing for complex claims, ensuring adherence to regulatory guidelines.
- Analyzed case files for accuracy and completeness, improving turnaround times on appeal resolutions.
- Collaborated with cross-functional teams to develop streamlined processes for claims handling.
- Trained junior staff on appeals procedures and best practices, enhancing team performance and efficiency.
Associate Customer Care Coordinator / Call Center Customer Service Representative
Total Med
08.2022 - 12.2024
- Assisted clients with government program applications, including SNAP EBT (Food Stamps), Medicaid (Oregon Health Plan), and ERDC.
- Provided case renewal guidance and support for preliminary applications and recertification's.
- Offered alternative methods for application submission via online portals, phone, or local offices.
- Processed updates to client profiles, including address changes and demographic corrections.
- Communicated approval and denial details for medical benefit coverage and referred clients to additional resources.
- Facilitated seamless transitions to eligibility departments for further case resolution.
Prior Authorization Specialist
Managed Staffing
Las Vegas, NV
11.2021 - 01.2022
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Input all patient data regarding claims and prior authorizations into system accurately.
Case Manager Processor
Robert Half, Howard Hughes Parkway
Las Vegas, NV
04.2021 - 08.2021
- Followed guidelines when reviewing applicant data to determine eligibility for economic rental assistance.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
Customer Service Representative
Mindlance
Parkway, SD
04.2018 - 03.2020
- Provided disclosure of benefits, provided alternative medications upon request.
- Provided primary customer support to internal and external customers.
- Contacted insurance companies to obtain prior authorization for medical procedures and medications.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
Prior Authorization Representative
Alorica
Las Vegas, NV
12.2018 - 01.2020
- Tracked referral submission during facilitation of prior authorization issuance.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Reviewed insurance coverage for patients to determine which party was liable for payment.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Verified eligibility and compliance with authorization requirements for service providers.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Contacted insurance companies to obtain prior authorization for medical procedures and medications.
CS Specialist
VDart
Alpharetta, GA
08.2018 - 10.2018
- Investigated vehicle damages, gathering information from diverse sources and delivering comprehensive reports.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
Customer Service Representative
Sutherland Global, AT&T
Las Vegas, NV
06.2016 - 12.2017
- Processed upgraded programming packages.
- Provided primary customer support to internal and external customers.
- Responded to customer requests for products, services and company information.
- Reviewed and solved account and billing discrepancies.
- Identified, researched and resolved billing variances to maintain system accuracy and currency.
- Leveraged sales expertise to promote products and capitalized on upsell opportunities.
- Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.
Education
Community College of Southern Nevada
Las Vegas, NVAnthropology, History, Criminal Justice, Sociology with Communications with Science
The University of Phoenix
Las Vegas, NVSkills
- Authorizations
- Effective communication skills
- Basic medical terminology
- Document and Records Management
- Microsoft Office Suite
- Client communication
- Understanding of insurance details
- Claim research
- Coverage assessments
- Establishing and Maintaining Customer Relationships
- Problem resolution
Timeline
Prior Authorization Determination Appeals Rep
SGS Consulting, Temporary Contract With CVS
10.2025 - 04.2026
Associate Customer Care Coordinator / Call Center Customer Service Representative
Total Med
08.2022 - 12.2024
Prior Authorization Specialist
Managed Staffing
11.2021 - 01.2022
Case Manager Processor
Robert Half, Howard Hughes Parkway
04.2021 - 08.2021
Prior Authorization Representative
Alorica
12.2018 - 01.2020
CS Specialist
VDart
08.2018 - 10.2018
Customer Service Representative
Mindlance
04.2018 - 03.2020
Customer Service Representative
Sutherland Global, AT&T
06.2016 - 12.2017
Anthropology, History, Criminal Justice, Sociology with Communications with Science
The University of Phoenix
Community College of Southern Nevada