Prior Authorization & Regulatory Compliance Specialist
Resume:
LYNNE WASHINGTON
LAS VEGAS, NV *****
702-***-**** *********@*****.***
PROFESSIONAL SUMMARY
Organized professional knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in the medical industry, communicating effectively orally and through writing and developing prior authorization workflows.
WORK HISTORY
SGS Consulting Recruiting Services, Contractual Temporary Position For CVS
Prior Authorization Coverage Determination & Appeals Representative II
October 2025-April 2026
Retrieved incoming calls, conversed with medical staffers, physicians, pharmacists, nurses,
technicians and members, etc.
TOTAL MED
Associate Customer Care Coordinator /Call Center Customer Service Representative Remote
August 2022 - December 2024
Assisted clients with government program applications, including SNAP EBT (Food Stamps), Medicaid
(Oregon Health Plan), and ERDC.
Provided case renewal guidance and support for preliminary applications and recertification's.
Offered alternative methods for application submission via online portals, phone, or local offices.
Processed updates to client profiles, including address changes and demographic corrections.
Communicated approval and denial details for medical benefit coverage and referred clients to additional resources.
Facilitated seamless transitions to eligibility departments for further case resolution. MANAGED STAFFING
Prior Authorization Specialist Las Vegas, NV November 2021 - January 2022
Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Input all patient data regarding claims and prior authorizations into system accurately. ROBERT HALF, HOWARD HUGHES PARKWAY
Case Manager Processor Las Vegas, NV April 2021 - August 2021
Followed guidelines when reviewing applicant data to determine eligibility for economic rental assistance.
Reviewed applications for different aid programs and determined which qualification criteria for individuals.
MINDLANCE
Customer Service Representative Parkway, SD April 2018 - March 2020
Provided disclosure of benefits, provided alternative medications upon request
Provided primary customer support to internal and external customers.
Contacted insurance companies to obtain prior authorization for medical procedures and medications.
Tracked referral submission during facilitation of prior authorization issuance.
Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
Followed guidelines when reviewing applicant data to determine eligibility for economic assistance. ALORICA
Prior Authorization Representative Las Vegas, NV December 2018 - January 2020
Tracked referral submission during facilitation of prior authorization issuance.
Input all patient data regarding claims and prior authorizations into system accurately.
Reviewed insurance coverage for patients to determine which party was liable for payment.
Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Verified eligibility and compliance with authorization requirements for service providers.
Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
Contacted insurance companies to obtain prior authorization for medical procedures and medications. VDART
CS Specialist Alpharetta, GA. August 2018 - October 2018
Investigated vehicle damages, gathering information from diverse sources and delivering comprehensive reports.
Worked with claims adjusters and examiners to expedite processing in alignment with procedures. SUTHERLAND GLOBAL, AT&T
Customer Service Representative Las Vegas, NV June 2016 - December 2017
Processed upgraded programming packages
Provided primary customer support to internal and external customers.
Responded to customer requests for products, services and company information.
Reviewed and solved account and billing discrepancies.
Identified, researched and resolved billing variances to maintain system accuracy and currency.
Leveraged sales expertise to promote products and capitalized on upsell opportunities.
Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.
EDUCATION
STUDIED AT
Community College of Southern Nevada
Las Vegas, NV
STUDIED AT Anthropology, History, Criminal Justice, Sociology with Communications with Science The University of Phoenix
Las Vegas, NV
SKILLS
Authorizations Understanding of insurance details
Effective communication skills Claim research
Basic medical terminology Coverage assessments
Document and Records Management Establishing and Maintaining Customer Relationships
Microsoft Office Suite Problem resolution
Client communication
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