Nadine McCoy
Buckeye,US
Summary
Healthcare Supervisor with extensive expertise in medical administration and claims processing. Demonstrates impactful leadership through optimized call management and effective training programs that enhance operational efficiency and patient satisfaction.
Overview
13
13
years of professional experience
Work History
Benefits and Prior Authorization Coordinator
Spectrum Medical Care
Phoenix, Arizona
10.2025 - Current
- Verified insurance benefits and coverage requirements prior to submission of authorization requests to ensure compliance and accuracy.
- Supported prior authorization requests for Spectrum Medical Care patients and providers.
- Worked with payers to resolve prior authorization questions and missing information.
- Monitored authorization status through electronic health records and internal work queues.
- Reviewed prior authorization requests against established criteria and protocols.
- Reviewed medical records and supporting documents for submission accuracy.
- Worked with the clinical staff to collect authorization details and treatment notes.
- Updated patients and provider teams on approval, denial, or pending authorization changes.
- Maintained referral and authorization records to support billing and scheduling workflows.
- Contacted insurance carriers to obtain authorization notices and pre-certifications for patients.
- Notified ordering providers of denied authorizations.
- Scheduled peer-to-peer reviews for physicians to discuss medical necessity with insurance providers.
- Helped resolve issues and appealed denied authorizations.
- Maintained files for referral and insurance information and entered referrals into system.
- Applied Medicare, Medicaid, and third-party payer guidelines while using online eligibility systems to verify coverage and policy limits.
- Worked with internal departments to provide account status updates.
- Scheduled patient appointments, diagnostic appointments, tests, and procedures.
- Followed federal, state, local laws, rules, and regulations related to area of responsibility.
- Reviewed denied claims to identify issues that could be addressed sooner.
- Collaborated with providers to gather missing information for authorization submissions.
- Kept current on healthcare reimbursement policies, regulations, and industry trends.
- Responded promptly to provider inquiries regarding authorization status and policy information, enhancing communication and support.
- Completed daily audits to check accuracy of prior authorization processes.
- Researched payer coverage policies, procedures, and requirements.
- Managed provider credentialing files for healthcare organization compliance.
- Assessed applications against CAQH profiles and payer requirements to ensure adherence to credentialing standards.
- Coordinated primary source verification for licenses, certifications, and malpractice coverage.
- Tracked credentialing status through internal databases and payer portals.
- Prepared recredentialing packets and assigned follow-up tasks across credentialing workflows.
- Prepared recredentialing packets and assigned follow-up tasks across credentialing workflows.
Benefits and Prior Authorization Specialist
Novartis Corp
Buckeye, US
05.2023 - 10.2025
- Managed prior authorization requests for complex specialty medications.
- Optimized approval workflow by preparing detailed medical necessity documentation and providing comprehensive support to providers.
- Resolved complex insurance inquiries and guided patients through coverage steps while maintaining high service standards.
- Improved insurance verification workflows and resolved complex coverage issues to support patient satisfaction.
- Resolved insurance inquiries to enhance patient satisfaction and expedite claim resolution.
- Facilitated communication among providers, insurers, and patients to improve care coordination and ensure accurate coverage checks.
- Supported patient access workflows and helped coordinate cross-functional communication to speed care delivery and improve service quality.
- Assisted with patient access processes while following healthcare regulations and coordinating communication across stakeholders.
- Tracked detailed insurance requirements and maintained documentation in full compliance with healthcare regulations.
- Worked with medical staff to streamline communication and patient care processes.
- Completed intake tasks to gather essential patient information for processing. and entered data for all documents received into patient support program.
- Recorded specialty pharmacy updates on patient status for pending cases.
- Assisted patient services case manager team with daily follow-up on compliance with guidelines and relevant regulations.
- Supported patient check-ins to improve appointment accuracy and efficiency.
- Updated patient records to maintain data integrity and confidentiality.
- Sorted documentation to support timely processing and compliance with defined requirements.
- Submitted data to appropriate agencies and maintained quarterly reporting rates. Used electronic data capture. Followed federal reporting requirements. Responded to requests for data extracts, pulled data from assigned facility database, and generated reports as needed. Submitted forms and reports on time while maintaining source documentation.
Prior Authorization Admin Supervisor
CVS Health
Remote, US
05.2022 - 04.2023
- Spearheaded prior authorization operations for pharmacy benefits team, implementing efficient protocols while maintaining compliance standards.
- Led and mentored team of 15 inbound agents for pharmacy benefits management, implementing streamlined prior authorization protocols and performance monitoring systems.
- Managed call queues, enhancing customer experience through proactive supervision.
- Optimized call queue management and wait times through data-driven decisions, while maintaining strict quality standards and regulatory compliance.
- Collaborated with supervisors to optimize team support strategies.
- Partnered with cross-functional teams to streamline workflows and implement best practices, enhancing overall operational efficiency.
- Developed comprehensive training programs for new technologies and procedures, ensuring consistent service quality and team performance excellence.
- Managed medical billing operations and premium collections while maintaining accurate member account records and documentation standards.
Member Advocate Supervisor
Maxor National Pharmacy Services Company
Tempe, US
10.2019 - 02.2022
- Led and mentored team of 15 inbound agents, implementing comprehensive training programs and performance monitoring systems for prior authorization processes.
- Led a team of 15 agents, optimizing medical prior authorization processes.
- Implemented performance monitoring systems for prior authorization team, optimizing response times and achieving consistently high customer satisfaction ratings.
- Conducted quality monitoring assessments and developed targeted coaching strategies to elevate customer service standards.
- Trained staff on compliance procedures and operational processes to enhance service delivery.
- Streamlined call queue management and optimized workflow to ensure timely completion of outbound calls and work assignments.
- Monitored call queues to minimize wait times and enhance customer experience.
- Partnered with cross-functional department leaders to implement efficient operational protocols and enhance team support mechanisms.
Benefits Investigation Supervisor
McKesson
Tempe, US
08.2018 - 09.2019
- Led benefits investigation team, managing workflow distribution and quality monitoring to ensure exceptional service standards for insurance authorizations.
- Led team in securing medication benefits, enhancing authorization efficiency and ensuring timely access for patients.
- Optimized team performance through systematic monitoring, regular quality assessments, and data-driven feedback, ensuring consistent service excellence.
- Mentored team members through personalized coaching sessions and implemented training programs that supported professional growth.
- Collaborated with management to refine support strategies, strengthening agent development and operational effectiveness.
- Managed call center operations, streamlining processes to reduce wait times and improve customer satisfaction.
- Streamlined call center operations through strategic queue management and performance tracking, enhancing customer satisfaction and reducing waiting times.
- Implemented automated benefits verification system, integrating insurance databases to expedite authorization processes and improve accuracy.
Prior Authorization Supervisor
RITE CARE PHARMACY
Dallas, US
08.2015 - 08.2018
- Led prior authorization processes and insurance negotiations while managing team workflow, ensuring compliance with healthcare regulations and optimizing medication alternatives for cost efficiency.
- Led insurance authorization processes, verifying accurate prescription use and identifying cost-saving alternatives.
- Streamlined authorization procedures and coordinated medical billing for premium collections, supervising team operations to ensure seamless workflow.
- Developed and implemented training programs for new analysts, reinforcing quality standards and providing ongoing guidance.
- Trained new analysts in procedures, enhancing team efficiency and knowledge.
- Assisted in hiring and distributing workflow, fostering team cohesion and supporting productivity.
- Monitored attendance and issued corrective actions, maintaining team discipline.
- Assisted billing department with payment collection tasks to ensure timely financial transactions. with payment collection processes, ensuring financial accuracy.
Claims Representative
Blue Cross Blue Shield
Tucson, US
11.2013 - 05.2015
- Improved customer satisfaction by promptly resolving claims issues and consistently meeting service quality standards.
- Streamlined claims processing workflow by coordinating with behavioral health providers, managing authorizations, and resolving complex eligibility inquiries.
- Created claims processing framework integrating provider authorizations and eligibility checks to minimize processing delays.
- Partnered with cross-functional teams to process authorizations, verify eligibility, and facilitate seamless healthcare service delivery.
- Verified eligibility and benefits, resolving claims issues efficiently.
- Coordinated care and referrals for behavioral health services.
- Facilitated member access to behavioral health resources, enhancing care coordination and treatment plan implementation.
- Handled member inquiries, ensuring compliance with confidentiality standards and improving member trust.
Education
Bachelor of Science - Health Administration management
Western Governors University
Mill creek, UT01-2027
AA - LIBERAL ARTS AND BEHAVIORAL SCIEN
College of The Canyons
Valencia06-2009
Skills
- Insurance Verification
- Coverage verification
- Claims Processing
- Healthcare Administration
- Healthcare compliance
- Epic
- EMR Systems
- ICD-10
- Medical Terminology
- Process optimization
- Data Management
- Operational Leadership
- Team leadership
- Team supervision
- Patient Services
- Patient Support
- Insurance Coordination
- Compliance standards
- Prior authorization
- Insurance verification
Languages
- English, Native
- Arabic, Native
Timeline
Benefits and Prior Authorization Coordinator
Spectrum Medical Care
10.2025 - Current
Benefits and Prior Authorization Specialist
Novartis Corp
05.2023 - 10.2025
Prior Authorization Admin Supervisor
CVS Health
05.2022 - 04.2023
Member Advocate Supervisor
Maxor National Pharmacy Services Company
10.2019 - 02.2022
Benefits Investigation Supervisor
McKesson
08.2018 - 09.2019
Prior Authorization Supervisor
RITE CARE PHARMACY
08.2015 - 08.2018
Claims Representative
Blue Cross Blue Shield
11.2013 - 05.2015
Bachelor of Science - Health Administration management
Western Governors University
AA - LIBERAL ARTS AND BEHAVIORAL SCIEN
College of The Canyons