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eviCore Healthcare
florham park,NJ
9
years of professional experience
Detail-oriented professional with extensive experience in prior authorizations and provider support, committed to delivering precise and efficient service. Strong focus on compliance ensures adherence to industry standards while consistently surpassing performance expectations. Proven ability to streamline processes and enhance operational efficiency, contributing to improved outcomes for both providers and patients. Passionate about fostering positive relationships within healthcare environments to support seamless service delivery.
Work History
Prior Authorization Specialist
4 Years- Serve as the primary point of contact for healthcare providers and medical facilities regarding prior authorization inquiries across multiple health plans.
- Research member benefits, payer guidelines, and authorization requirements to provide accurate information and resolve complex requests.
- Process updates and permissible modifications to existing authorizations while ensuring compliance with health plan policies and procedures.
- Maintain thorough, accurate documentation of all interactions and case activity in accordance with HIPAA and organizational standards.
- Balance a high-volume workload while consistently meeting performance goals for quality, productivity, adherence, and customer satisfaction.
Call Center Representative
1 Year- Answered high-volume inbound calls while maintaining excellent customer satisfaction.
- Resolved customer concerns and documented interactions in CRM systems.
- Provided professional service through active listening and problem solving.
Shift Supervisor RX
1 Year 8 Months- Supported pharmacy operations and customer service.
- Verified insurance benefits and maintained patient records.
- Optimized workflow and team productivity.
Front Desk Manager
1 Year 9 Months- Managed guest services, reservations, and check-in/check-out.
- Resolved guest concerns and coordinated with hotel departments.
Education
Diploma
Skills
Prior Authorization Processing
Health Insurance Verification
Medical Terminology
HIPAA Compliance
Utilization Management Support
Detail-oriented data management
Compliance & Regulatory Knowledge
Timeline
Prior Authorization Specialist
eviCore Healthcare
07.2022 - CurrentRead More
Call Center Representative
Century Fasteners
06.2021 - 06.2022Read More
Shift Supervisor RX
CVS Pharmacy
02.2019 - 10.2020Read More
Front Desk Manager
Holiday Inn Express
12.2017 - 09.2019Read More
High Point Central High School
Diploma
Read More