Remote Prior Authorization & Utilization Review Specialist

Natalie Bennett

Plano, IL 630-***-**** ************@*****.***

Remote Prior Authorization Specialist Patient Service Representative Utilization Review Support

PROFESSIONAL SUMMARY

Results-driven healthcare professional with 10+ years of experience in prior authorization, insurance verification, patient services, and utilization review support. Extensive knowledge of Medicare, Medicaid, and commercial payer guidelines. Maintain strict HIPAA compliance and regulatory standards. Experienced in remote environments using EPIC, Cerner, Salesforce, and EHR systems. Recognized for accuracy, productivity, and exceptional customer service.

CORE COMPETENCIES

Prior Authorization Processing (Medical & Pharmacy) Utilization Review Support Insurance Verification (Medicare, Medicaid, Commercial) Benefits Investigation & Eligibility Medical Terminology CPT & ICD-10 Familiarity Patient Scheduling & Care Coordination HIPAA Compliance & Documentation EPIC Cerner Salesforce EHR Systems High-Volume Call Center Operations Remote Work & Virtual Team Collaboration Microsoft Office Suite

Rush Orthopedics & Sports Med

May 2026 to Present

Ensures an exceptional experience for patients when greeting, checking in, and checking out during their appointment;

Answers incoming phone calls

Checks in and out during appointments, answers calls, responds to patient requests, takes messages, and schedules appointments.

PROFESSIONAL EXPERIENCE

CVS Caremark

Commercial Prior Authorization (Remote) Sept 2025 – May2026

Review and process prior authorization requests according to payer clinical guidelines

Evaluate medication coverage and determine authorization eligibility

Communicate with providers, pharmacies, and members regarding authorization status

Maintain accurate documentation in compliance with regulatory and company standards

Manage high-volume workload while meeting turnaround time requirements

Everise Healthcare

Patient Service Representative (Remote Contract) Nov 2023 – Sept 2025

Handled high-volume inbound calls assisting patients with insurance, benefits, and authorization inquiries

Verified insurance eligibility and benefits across multiple payer systems

Documented patient interactions accurately in electronic systems

Assisted with pre-authorizations and benefits clarification

Delivered excellent customer service while meeting performance metrics

AdventHealth

Central Scheduling Customer Service Representative (Remote Contract) Apr 2023 – Oct 2023

Scheduled patient appointments and coordinated care across departments

Verified insurance coverage and obtained required prior authorizations and referrals

Ensured accurate patient records and compliance with payer requirements

Communicated effectively with patients, providers, and insurance companies

CVS Specialty Pharmacy

Prior Authorization Specialist Jan 2020 – Mar 2021

Processed prior authorizations for specialty medications

Verified benefits and eligibility with insurance providers

Communicated with providers to obtain required clinical documentation

Assisted patients with coverage questions and authorization status

Maintained productivity in a high-volume call environment

Nephrology Associates

CMA Prior Authorization Specialist Jan 2017 – Dec 2019

Processed prior authorizations and insurance verification for specialty treatments

Coordinated referrals and communicated with insurance providers

Documented patient records in EHR systems

Assisted providers with authorization requirements and documentation

First Transit

Customer Service Representative Feb 2011 – Dec 2016

Verified insurance eligibility including Medicare and Medicaid

Scheduled transportation services for patients

Provided customer support and resolved service-related issues

Maintained accurate documentation and customer records

EDUCATION

GED Illinois Community College Board

CERTIFICATIONS

CPR Certified

First Aid Certified

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