Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Natasha Hall

Hockley,Texas

Summary

Personable and dedicated Prior Authorization Representative with 8 years of experience in the healthcare industry. Expert in customer relations, adept at handling diverse concerns with a solution-focused mindset and keen attention to detail. Skilled in research, documentation, and problem-solving, excelling in improving customer satisfaction, problem de-escalation, call quality, and efficiency. Quick to adapt to new computer programs and systems, eager to bring proven abilities to benefit your company.

Overview

11
11
years of professional experience

Work History

Prior Authorization Representative

CVS Caremark
07.2024 - Current
  • Responsible for answering the inbound calls from prescribers, members, and other healthcare professionals. As well as making outbound calls to doctors to obtain necessary information to decide cases.
  • Managed 56+ incoming faxes and created coverage determination and appeal cases per day.
  • Responsible for maintaining complete, timely, and accurate documentation of all approvals and denials.
  • Navigating multiple software systems to document conversations and outcomes.
  • Reviewing and making decisions on requests for medication coverage.
  • A strong understanding of clinical criteria, drug information, and insurance benefits.
  • Work with a team of pharmacists, technicians, and medical professionals to process appeals and resolve complex cases.
  • Identify and escalate complex or problematic cases that require specialized expertise.

Prior Authorization Representative

Broad Path
03.2024 - 06.2025
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Followed all Medicare, Medicaid, HIPAA and private insurance regulations and requirements.
  • Collaborated with internal departments to provide account status updates.
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Developed strategies for resolving complex issues concerning benefit coverage determinations.
  • Submitted prior authorization requests electronically or by phone to payers.
  • Assessed insurance benefits and determined eligibility criteria.
  • Reviewed prior authorization requests for completeness and accuracy.

Customer Service Representative

Accredo Specialty Pharmacy
09.2022 - 06.2023
  • Managed incoming calls from patients and other healthcare facilities to provide information or schedule services.
  • Provided customer service by answering inquiries, resolving complaints, and providing general information to clients regarding healthcare services.
  • Maintained client confidentiality according to HIPAA regulations at all times.
  • Resolve customer complaints through independent problem-solving skills and one-call resolution
  • Take calls back-to-back while toggling through several applications on multiple screens
  • Understand and strive to meet or exceed call center metrics while providing excellent consistent customer service

Client Support Representative

American Funding
04.2022 - 08.2022
  • Provided technical support to customers via phone, email and chat.
  • Performed basic diagnosis on products to help determine cause of issue.
  • Resolved customer inquiries in a timely manner.
  • Developed knowledge base articles for frequently asked questions.
  • Demonstrated strong sense of ownership for customer issues, displaying empathy and maintaining productive dialogue throughout open requests.
  • Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
  • Documented all relevant customer information accurately in the database system.

Customer Service Team Leader

Urgent.ly
06.2020 - 02.2022
  • Oversee daily operations of contact center teams by planning, directing, and evaluating team performance to ensure customer satisfaction, compliance, and standards
  • Monitored interactions, workflow, and metrics of the contact center to ensure adherence to performance, quality, and efficiency standards
  • Provided training and coaching to direct reports for operational improvement within the contact center
  • Analyzed call volume trends and implemented strategies to improve efficiency of the team.
  • Responsible for handling more complex issues related to our members and providers
  • Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
  • Engaged in conversation with customers to understand needs, resolve issues and answer service questions.

Certified Nurse Assistant

Gardena Convalescent Center
01.2020 - 06.2020
  • Provided compassionate care to elderly, disabled and terminally ill individuals.
  • Observed patient behavior and reported any changes to the supervising nurse.
  • Maintained accurate records of patient progress and condition.
  • Checked vital signs, including temperature, pulse, respiration rate, blood pressure and oxygen saturation levels.
  • Collected samples for laboratory testing under the direction of a registered nurse or physician.
  • Performed bedside care procedures such as catheterizations, enemas, douches and irrigations.
  • Participated in team meetings with nurses, physicians and other healthcare personnel regarding patient care needs.

Motor Vehicle Field Representative

Department of Motor Vehicles
07.2019 - 11.2019
  • Provide in-person assistance and superior customer service, Working the lobby, Checking in Appointments, and non-appointment Customers
  • Furnish the public with and explain the use of forms and applications for registration and driver license/identification transactions; inspect documents for authenticity, signatures, and completeness of information; verify customer identity.
  • Handle sensitive and confidential documents; identify and/or flag suspicious behavior or potentially fraudulent documents
  • Process various forms and documents pertaining to driver licensing, vehicle registration and ownership, occupational licensing, and other related matters to complete the requested transactions
  • Performed detailed inspections of motor vehicles for safety and emissions compliance.
  • Conducted field tests to ensure proper operation of vehicle components.

Office Attendant

Diamond Parking
11.2014 - 02.2016
  • Organized files, developed spreadsheets, faxed reports and scanned documents to improve organizational workflow.
  • Greeted and welcomed visitors, clients, and customers in a professional manner.
  • Ensured the cleanliness of office spaces, including vacuuming, dusting, and mopping.
  • Delivered mail to various departments within the organization.
  • Maintained office equipment such as printers and copiers by troubleshooting technical problems and contacting service providers for repairs.
  • Compiled and sorted documents, such as invoices and checks, substantiating business transactions; Direct contact with Loomis
  • Verifies and posts details of business transactions, such as funds received and disbursed, and totals accounts to ledgers or computer spreadsheets and databases
  • Properly collect, record, and deposit in the designated bank all monies or cash equivalents and accompanying documentation at the end of each shift

Education

Some College (No Degree) - Criminal Justice Administration

California State University of Dominguez Hills
Carson, CA

High School Diploma -

Juan Rodriguez Cabrillo High School
Long Beach, CA
06-2013

Skills

  • HIPAA Compliance
  • Medical Terminology
  • Data entry proficiency
  • Cover determination requests
  • Workflow management
  • Excellent in Microsoft Office Suite (including Outlook, Word, Excel, and PowerPoint)
  • Customer Relationship Management (CRM)
  • Excellent spoken and written communication skills
  • Multi-tasking and prioritize skills
  • Problem and Conflict Resolution
  • Strong interpersonal skills
  • Call center operations

References

References available upon request.

Timeline

Prior Authorization Representative

CVS Caremark
07.2024 - Current

Prior Authorization Representative

Broad Path
03.2024 - 06.2025

Customer Service Representative

Accredo Specialty Pharmacy
09.2022 - 06.2023

Client Support Representative

American Funding
04.2022 - 08.2022

Customer Service Team Leader

Urgent.ly
06.2020 - 02.2022

Certified Nurse Assistant

Gardena Convalescent Center
01.2020 - 06.2020

Motor Vehicle Field Representative

Department of Motor Vehicles
07.2019 - 11.2019

Office Attendant

Diamond Parking
11.2014 - 02.2016

Some College (No Degree) - Criminal Justice Administration

California State University of Dominguez Hills

High School Diploma -

Juan Rodriguez Cabrillo High School

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