PATRICIA DIAZ
Summary
Dedicated Authorization Specialist with extensive experience in managing end-to-end authorization lifecycle and navigating complex insurance requirements for surgical procedures and specialty pharmaceuticals. Achieved significant reductions in denials and accelerated patient care through meticulous auditing of clinical documentation against payer policies. Focused on building lasting relationships and delivering exceptional customer service in fast-paced environments.
Overview
12
12
years of professional experience
1
1
year of post-secondary education
1
1
Certification
Work History
Case Manager / Patient Access Specialist
AssistRX
04.2025 - 02.2026
- Functioned as primary contact for patients, healthcare providers, and insurance payers, fostering communication and support throughout the authorization process.
- Specialty Authorizations: Managed benefit investigations and prior authorizations for high-cost pharmaceutical products and procedures, ensuring timely access to necessary treatments.
- Denial Management: Collaborated with payers to resolve reimbursement issues and submitted clinical documentation for successful appeals.
Premium Counselor / Surgical Coordinator
American Vision Partners
09.2020 - 03.2025
- Secured authorizations for surgical cases, ensuring compliance with all clinical prerequisites (H&Ps, consents, orders) to facilitate timely procedures.
- Educated patients on insurance coverage and financing options, promoting financial transparency and informed decision-making prior to surgery.
- Assisted clients in identifying personal goals and coping strategies.
- Provided individual and group counseling sessions for diverse populations.
- Developed treatment plans tailored to client needs and circumstances.
Pre-Access & Authorization Specialist
Phoenix Children’s Hospital
01.2015 - 01.2018
- Audited procedure requests against strict insurance standards, validating medical necessity and reducing repetitive denials.
- Data Accuracy: Cross-referenced CPT and diagnosis codes against physician orders to ensure submission integrity.
- Cross-referenced CPT and diagnosis codes with physician orders, ensuring accuracy of submissions and compliance.
Authorization Specialist
AZ Pain Specialists
01.2014 - 01.2015
- Processed patient insurance authorizations for pain management treatments.
- Coordinated authorization tasks, conducting clinical documentation review and following up with insurance portals and representatives to ensure timely approvals.
- Reviewed medical records to confirm eligibility and authorization requirements.
- Communicated with insurance representatives to resolve authorization issues.
Education
Associate of Applied Science - Occupational Therapy
Maricopa Community Colleges, Gateway Community College
Phoenix, AZ 06.2026 - 06.2026
Certification - Patient Care Technician
International Institute of The Americas
Phoenix, AZ 06.2005 - 07.2006
Premier Charter High School
Phoenix, AZSkills
- Clinical documentation
- Medical documentation
- H&P Review
- CPT coding
- CPT/HCPCS
- ICD-10 standards
- Authorization management
- Denial management
- Retro-Authorizations
- Patient evaluation
- Care coordination
- Insurance verification
- Relationship building
- Benefit counseling
- Insurance Advocacy
- Payer Portals
- Provider Liaison
- EMR/EHR Navigation
- OPS Billing System
- Advantx
- Commercial
- Medicare
- Medicaid
- Worker’s Compensation
- PBMs
- Microsoft Excel
- Microsoft Word
- Outlook
- SharePoint
- HIPAA Compliance
- Workflow efficiency
- Cash flow management
- Problem solving
- Relationship building
- Patient counseling
- Patient counseling
- Insurance verification
Certification
Patient Care Technician (PCT) Program, 01/01/06
Technical Toolkit
Advantx, OPS Billing System, EMR/EHR Navigation, SharePoint, Skilled in navigating various Commercial and Government insurance portals for real-time status tracking., Advanced Microsoft Excel (Workload Tracking), Microsoft Word, Outlook, HIPAA Compliance, CPT/HCPCS, ICD-10 Coding Standards
Core Competencies
Medical Necessity Documentation, H&P Review, CPT/ICD-10 Coding, Commercial, Medicare, Medicaid, Worker’s Compensation, PBMs, Appeals & Denials Management, Retro-Authorizations, Financial Clearance, Consistently exceeding productivity quotas (30–50+ accounts daily), Provider Liaison, Insurance Negotiator, Patient Financial Counseling
Timeline
Associate of Applied Science - Occupational Therapy
Maricopa Community Colleges, Gateway Community College
06.2026 - 06.2026
Case Manager / Patient Access Specialist
AssistRX
04.2025 - 02.2026
Premium Counselor / Surgical Coordinator
American Vision Partners
09.2020 - 03.2025
Pre-Access & Authorization Specialist
Phoenix Children’s Hospital
01.2015 - 01.2018
Authorization Specialist
AZ Pain Specialists
01.2014 - 01.2015
Certification - Patient Care Technician
International Institute of The Americas
06.2005 - 07.2006
Premier Charter High School