Healthcare Authorization & Insurance Specialist

Tatyana Gonzalez

407-***-**** *************@*****.*** Florida, United States

Professional Summary

Healthcare support professional with 7+ years of experience in specialty pharmacy, prior authorizations, insurance verification, and patient access services. Extensive knowledge of Medicare, Medicaid, Tricare, and commercial insurance guidelines. Experienced working in both onsite and remote environments supporting providers, pharmacies, and patients to obtain medication approvals and resolve coverage issues.

Professional Experience

BioPlus Specialty Pharmacy – Remote

Customer Service Representative (CSR) July 2025– Present

• Provide remote support to patients, providers, and specialty pharmacy teams regarding prescription status, insurance approvals, and medication coordination.

• Conduct benefit investigations and assist with prior authorization follow-ups for specialty medications.

• Document patient interactions, insurance updates, and authorization status in pharmacy management systems while maintaining HIPAA compliance.

• Resolve insurance coverage barriers by coordinating with providers, payers, and pharmacy teams to ensure timely medication access.

Alliance OB/GYN – Orlando, FL

Benefit Verification Specialist / Medical Receptionist Jan 2022 – July 2025

• Verify patient insurance eligibility and benefits for procedures, imaging, and OB/GYN specialty services.

• Submit and track prior authorizations and referrals with commercial insurance, Medicare, and Medicaid payers.

• Maintain accurate documentation within EMR systems including Athena while preparing patient charts for providers.

• Coordinate patient scheduling, collect copays, and communicate coverage requirements to ensure smooth clinical workflow.

CVS Pharmacy / CVS Specialty – Hybrid / Call Center Prior Authorization Specialist Jan 2020 – Jan 2022

• Managed high volume prior authorization cases for specialty medications and chronic disease therapies.

• Reviewed insurance criteria and payer policies to ensure accurate submission of clinical documentation.

• Communicated with physician offices, pharmacies, and insurance carriers to resolve authorization denials and coverage issues.

Skills

• Prior Authorization Processing • Insurance Verification & Benefit Investigation

• Specialty Pharmacy Workflow • Patient Access & Medication Coordination

• EMR/EHR Systems (Athena)• Medicare, Medicaid, Tricare & Commercial Payers

• HIPAA Compliance • Remote Healthcare Operations

• Patient Support & Care Coordination • Bilingual English / Spanish

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