Prior Authorization Access Specialist

Charles Arenas

Relevant Skill Set:

• **+ years of experience in Insurance Verification, prior authorization processing, coordination of benefits process and pharmacy claim rejections

• Experience with Medicaid, Medicare (Parts B & D) and commercial insurances

• Bilingual, speaking English and Spanish

• Strong computer skills; Excel, Availity, Navanet and CPR systems Professional Experience:

CVS Caremark – Orlando, FL

March 2019 to December 2019

Patient Access Specialist

• Handled 50+ inbound and outbound calls to members and physician offices

• Verified the patient's insurance benefits, to include deductible, out of pocket max, accumulated amounts, verify the Pharmacy Benefit Manager and if Prior Authorization is required

• Forward Prior Authorization documents to the Prescriber and follow up until these are completed and returned or sent to the payer

• Initiated and followed up on appeals if prior authorization is denied Advanced Care Scripts – Orlando, FL

November 2016 to June 2018

Prior Authorization Coordinator

• Verified insurance benefits and coverage, deductible, out of pocket maximum, amounts currently accumulated; and co-payments, prescription drug coverage, verified if Prior Authorization needed run Test claim in CPR

• If Prior Authorization is required verify approving authority, required documentation and follow up with provider until approval is obtaining to include appeals

• Reviewed EOB's, processed and completed payments to providers

• Contacted patient, advised of current benefits to include need of prior authorization, inquire if financial assistance is needed, assign for enrollment in the MS Touch program

• Provided needed documentation to get claims paid and correct claim errors for re-submission

• Processed and posted payments made and requests refunds when needed

• Experience with CMS 1500 and UB04 forms

• ICD 10 & CPT coding

CuraScripts– Orlando, FL

March 2015 to October 2016

Reimbursement Coordinator

• Reviewed Explanation of Benefits, to ensure payments received and posted are accurate

• Reverified insurance benefits to verify benefits

• Responsible for contacting payer if payment is denied or incorrect

• Reached out to insurance companies and patients to collect on accounts

• Provided needed documentation to get claims paid such as Prior Authorization to include proof of timely filing and or correct claim errors for re-submission

• Verified missing applied payments and corrected the posting error to "zero" balance the invoice BioSolutia – Lake Mary, FL

January 2014 to February 2015

Insurance Verification Coordinator

• Verified Rx Drug coverage effective dates, deductible, out of pocket maximum, amounts currently accumulated; and co-payments, to include Prior Authorization, Predetermination and or Medical exception requirements when needed

Charles Arenas

• Deciphered rejection codes and correct rejected claims to submit for adjudication

• Ensured claims are legitimate and in accordance with the terms of the policy Health First NY – Lake Mary, FL

October 2010 to December 2013

Provider Operations Specialist

• Provided administrative support to the sales/credentialing and claims processing departments

• Supervised projects involving commercial providers such as hospitals, medical clinics as well as private practices by verifying credentials and loading with correct fee schedules based on contract Education:

GED, Department of Education – Ponce, PR

Contact this candidate