Stephanie Rodriguez
Phoenix,AZ
Summary
Efficient Prior Authorization Specialist known for high productivity and ability to complete tasks swiftly. Possess specialized skills in insurance verification, medical coding (ICD-10 and CPT), and regulatory compliance. Excel at communication, problem-solving, and time management, ensuring smooth operation within healthcare settings.
Overview
12
12
years of professional experience
Work History
Prior Authorization Specialist
Cigna Corporation
Phoenix, AZ
11.2020 - Current
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Researched clinical criteria and determined eligibility for requested services based on plan provisions.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Reviewed and processed prior authorization requests for medical procedures and medications according to established guidelines.
Lead Customer Service Representative
Circle k
Phoenix, AZ
08.2018 - 03.2020
- Provide prompt and courteous customer service
- Training new employees
- Shift supervision
- Conducted daily store reports, Grocery store orders and deliveries
- Cash handling, bank deposits.
Customer Service Representative
CVS Caremark Specialty Pharmacy
Phoenix, AZ
08.2016 - 11.2017
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Assist doctor offices & facilities, healthcare insurance plans and patients regarding insurance benefits coverage & pre-authorization.
- Informed customers about billing procedures, processed payments, and provided payment option setup assistance.
Patient Pay Billing Representative
Med One Healthcare
Phoenix , AZ
08.2012 - 01.2014
- Verified patient insurance coverage, created financial plan according to treatment schedules for collections and communicated between patient and billing company regarding health insurance.
- Assisted customers with inquiries regarding their bills and payment options.
- Collaborated with other departments to resolve any outstanding billing issues quickly.
- Served as primary contact for internal departments concerning billing matters.
Education
High School Diploma -
South Mountain High School
Phoenix, AZ01.2002
Bachelor of Applied Studies - Psychology
Grand Canyon University
Phoenix, AZSkills
- Customer Service
- Data Entry
- Critical thinking abilities
- Interpersonal skills
- Leadership
- Organization & time management
- Insurance Verification
- Billing Procedures
- Precertification requirements
- Understanding of medical terms
- Insurance procedures
- Workflow Management
References
gladly furnished upon request
Timeline
Prior Authorization Specialist
Cigna Corporation
11.2020 - Current
Lead Customer Service Representative
Circle k
08.2018 - 03.2020
Customer Service Representative
CVS Caremark Specialty Pharmacy
08.2016 - 11.2017
Patient Pay Billing Representative
Med One Healthcare
08.2012 - 01.2014
High School Diploma -
South Mountain High School
Bachelor of Applied Studies - Psychology
Grand Canyon University
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