Prior Authorization Support Specialist
Resume:
P L
Paris Leath
Professional Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Work History
Harris Health Systems - Patient Access Management
Remote
04/2024 - Current
Apollo Healthcare - Patient Support Specialist
08/2020 - 04/2024
Sutherland Global - Medical Claims Representative
12/2017 - 08/2020
Empyrean Benefits Solutions - Client Service Representative 03/2015 - 12/2017
Interview incoming patients during intake, collecting personal, demographic, and medical history information. Accept, verify, and record insurance details; communicate with coverage providers to confirm eligibility and benefits.
●
Guide patients to appropriate clinical services, including physician examinations and diagnostic testing. Facilitate communication between patients, clinicians, and case management teams regarding patient status and next steps.
●
Manage high-volume inbound and outbound calls, assisting patients with scheduling, insurance, and billing inquiries.
●
Verified insurance prior to visits and obtained prior authorization for procedures. Collected copays and provided billing information to patients
●
Handle 80–150+ calls per day from patients, caregivers, and healthcare providers. Respond to inquiries related to appointments, billing, prescriptions, insurance, and medical services.
●
Schedule, reschedule, and cancel medical appointments using EMR systems
(e.g., Epic, Athena). Confirm and verify patient demographics, insurance, and appointment details.
●
Provide basic insurance guidance and explain patient financial responsibility. Assist with billing inquiries, payment plans, and balance resolution.
●
Relay refill requests and medication concerns to the appropriate clinical staff. Help coordinate prior authorization or pharmacy follow-ups if needed.
●
Processed and adjudicated inbound and outbound medical claims in compliance with payer guidelines and federal regulations.
●
Verified patient insurance eligibility, benefits, and prior authorizations for medical procedures and services. Provided patient education on Explanation of Benefits (EOBs), co-payments, deductibles, and balance billing.
●
Resolved claim denials, rejections, and appeals by reviewing supporting documentation and coordinating with providers and payers.
●
Responded to high-volume inbound calls from patients, providers, and insurance carriers regarding billing inquiries, claim status, and reimbursement.
●
Handle 80–120 inbound calls daily, assisting patients and providers with benefit verification, billing, claims, and prior authorization inquiries.
●
Provide clear and accurate information on coverage, copays, deductibles, and plan options. Assisted members with insurance eligibility, claims status, and billing inquiries.
●
Coordinated prior authorization and referral requests with providers and payers. Supported Medicare/Medicaid members during enrollment and annual plan changes.
●
Supported Medicare/Medicaid members during enrollment and annual plan changes. Verified patient insurance coverage and collected necessary documentation.
●
*************@*****.***
Houston TX
Skills
● Customer service
● Data entry
● Insurance verification
● Patient confidentiality
● Appointment scheduling
● Follow-up skills
● Medical billing
● Patient Intake & Registration
● Benefits Coordination
● Billing & Payment Processing
Electronic Health Records (EHR/EMR)
Data Entry
●
Call Center Operations
(Inbound/Outbound)
●
● Email Support
● Chat Support
● Remote Operations
● Claims Processing
● Prior Authorization
● Case Documentation & Status Updates
● Provider & Payer Liaison Support
● Empathy and patience
● CPT, CDT, ICD-10, HCPCS Codes
● Enrollment processing
● EOB analysis
● Athenahealth,Epic
● Patient & Provider Support Services
● Medicare expertise
● Claims processing
Education
Klein Forest High School
High School Diploma
Contact this candidate