Natasha Grable
Palmetto,FL
Summary
Compassionate Customer Service Representative experienced in coordinating patient care and facilitating communication between patients and healthcare teams. Achieved consistently positive healthcare experiences through a patient-centered approach and expertise in prior authorization processes and insurance verification. Delivered prompt solutions by leveraging problem-solving skills in dynamic healthcare environments.
Overview
11
11
years of professional experience
Work History
Prior Authorization Specialist
Capsule
Remote, FL
07.2022 - 02.2026
- Completed prior authorization forms, negotiated authorization status with insurers, tracked prescription approval status, and alerted clinical pharmacists of denials or nonresponse to ensure timely patient care.
- Assessed and initiated the Prior Authorization (PA) process, ensuring alignment with provider recommendations and customer preferences.
- Resolved insurance issues through effective communication with doctors, customers, and insurance companies.
- Clearly explain prescription options to customers and providers, prioritizing the best outcome for the customer.
- Expedite clinic workflow and enhance patient care by preventing therapy interruptions due to insurance issues in conjunction with pharmacists, physicians, and clinic staff.
- Ensured coding on claims adhered to payer guidance, optimizing reimbursement from third-party payers.
Complaints and Grievances Specialist
United Healthcare
Remote, FL
10.2019 - 07.2022
- Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance, and reconsideration requests.
- Managed high volume of diverse health insurance appeal-related correspondence to ensure timely resolutions.
- Respond to a diverse and high volume of health insurance appeal-related correspondence daily.
- Identified, researched, processed, and resolved customer inquiries through written and verbal communication, enhancing customer satisfaction.
- Maintained complete and accurate records in accordance with department policy to support compliance and operational efficiency.
Patient Account Representative - Verifications
Tampa General Hospital, St. Joseph's Hospital
Tampa, FL
05.2015 - 10.2019
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining necessary authorization numbers.
- Interpreted Explanation of Benefits statements and communicated relevant information with other departments.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
Education
Diploma -
Palmetto High School
Palmetto, FLSkills
- Prior authorization
- Insurance Authorization
- Insurance Verification
- Claims Management
- Data Analysis
- Microsoft Office Suite
- COB/EOB explanation
- Patient Registration
- Referral Coordination
- Data Entry
- Medical Terminology
Timeline
Prior Authorization Specialist
Capsule
07.2022 - 02.2026
Complaints and Grievances Specialist
United Healthcare
10.2019 - 07.2022
Patient Account Representative - Verifications
Tampa General Hospital, St. Joseph's Hospital
05.2015 - 10.2019
Diploma -
Palmetto High School