Nina Bekauri
City DME
Brooklyn
3
Languages
4
years of professional experience
Detail-oriented Prior Authorization and Insurance Verification Specialist with 4 years of experience in Medicare, Medicaid, and commercial insurance. Skilled in managing prior authorizations, verifying insurance eligibility, reviewing medical records, and resolving authorization issues. Capable of efficiently handling high volumes of work while maintaining effective communication with insurance providers and healthcare teams.
Work History
Prior Authorization & Insurance Specialist
2 Years 6 Months- Managed authorizations for DME across Medicare, Medicaid, and Commercial insurance plans while ensuring compliance with payer guidelines.
- Tracked authorization approvals, denials, and pending cases, ensuring accurate documentation and timely follow-up with insurance plans to support patient care.
- Collaborated with intake, billing, providers, and clinical staff to obtain required documentation and facilitate timely authorization decisions.
- Reviewed prescriptions, clinical documentation, and authorization requests to ensure compliance with payer requirements and medical necessity criteria.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing online eligibility systems to verify patient coverage and policy limitations.
- Identified reasons for denied claims and collaborated with insurance carriers to resolve issues, facilitating smoother authorization processes.
- Documented medical claims and prior authorization requests for processing.
- Monitored changes in insurance policies and guidelines to ensure compliance with prior authorization processes.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients, ensuring clarity and timely updates on patient status.
Prior Authorization Specialist
2 Years 9 Months- Processed prior authorization requests for medical supplies and equipment.
- Verified member eligibility, insurance benefits, and authorization requirements, collaborating with payers to expedite approval processes.
- Maintained detailed records of authorization approvals and denials to support compliance and operational efficiency.
- Communicated with healthcare providers to gather necessary documentation.
- Reviewed patient information to ensure alignment with insurance guidelines and improve approval rates.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Applied medical coding knowledge to ensure precise processing and documentation of authorization requests.
- Trained new staff on prior authorization procedures and company policies.
- Entered claims and prior authorizations into the medical records system.
- Reviewed prior authorization requests for accuracy and completeness, enhancing approval likelihood.
Education
BBA - Business Administration
Skills
Authorization Management
Eligibility verification
HCPCS Codes
Denial Resolution
Data entry accuracy
Claims Management
Problem solving
Provider relations
Payer Policy Compliance
Medicare
Medicaid
Commercial Insurance
Medical Documentation Review
Medical Necessity Review
ICD-10 Diagnosis Codes
Provider Relations
Detail-Oriented
Time Management
Team collaboration
Workflow management
LANGUAGES
English: Native/ Bilingual
Georgian: Native/ Bilingual
Russian: Limited
Timeline
Prior Authorization & Insurance Specialist
City DME
02.2024 - 08.2026Read More
Prior Authorization Specialist
Family Medical Supply
03.2022 - 12.2024Read More
Business And Technology University
BBA from Business Administration
Read More