Faith O.
Mid-Level Prior Authorization Specialist
Open to offersNew to PlatformAbout
Faith O. is a proficient Prior Authorization Specialist with extensive experience in managing insurance verification and authorization processes, particularly within the oncology, radiology, cardiology, and physical therapy sectors. During her tenure at Medmetrix LLC, she excelled in securing prior authorizations for oncology IV drug medications by utilizing EHR systems like MOSAIQ and payer portals, alongside efficiently handling inbound calls to schedule appointments and managing paperwork to ensure seamless patient experiences. At Conifer Health Solutions Inc., Faith effectively processed diagnostic imaging test authorizations and insurance eligibility verifications, adeptly navigating Epic EHR to manage a high volume of patient cases daily. Her role involved detailed coordination with nurse reviewers for authorization reconsiderations and ensuring documentation compliance to prevent claims denials. Faith's skill set includes proficiency in EHR platforms such as NextGen and Athenahealth, and she is recognized for her meticulous attention to detail and adherence to HIPAA compliance.
Experience
Prior Authorization Specialist
Medmetrix LLC · 2026 — 2026Managed verification of patient insurance and prior authorization requests for Oncology IV drug medication using EHR- MOSAIQ and payer portals. Scheduled appointments through inbound patient calls and coordinated appeals and peer discussions to address denials. Conducted outbound calls to verify authorization status and secured supplementary clinical records. Processed authorizations for physical therapy evaluations and managed patient registration with EHR-NextGen, while transmitting medical records to facilitate authorization approval.Clinical Authorization Representative II
Conifer Health Solutions Inc. · 2026 — 2026Processed authorizations for diagnostic imaging tests and referral orders, while verifying insurance eligibility according to payer requirements using Epic EHR, managing around 50-70 patients daily, including follow-ups. Utilized payer portal for verification of patient insurance eligibility and submitted authorization requests. Conducted outbound calls to verify authorization status, ensuring all necessary clinical documentation was received to prevent claims denials and collaborated with nurse reviewers for reconsiderations.Patient Care Coordinator I
Allsectech Manila Inc. · 2025 — 2026Handled inbound and outbound calls regarding patient referral statuses and performed follow-ups with Village Medical Clinic PCP and nurses to check on referrals and medical records. Maintained detailed documentation throughout the PCP referral order process, offered in-network specialist options according to patient insurance coverage, and facilitated authorization processing for specialist appointments while ensuring the transmission of medical records to specialists.Utilization Management Representative I
Carelon Global Solutions · 2022 — 2023Managed inbound calls from Anthem Blue Cross Blue Shield providers, addressing authorization-related inquiries. Initiated and followed up on pre-authorization cases for both inpatient and outpatient procedures in line with plan guidelines. Provided timely updates on the status of authorization requests and directed calls to the relevant teams to enhance the efficiency of resolution and support workflow needs.
Skills & Expertise
Education
- Bachelor of science in Tourism and Hospitality ManagementInstitution not specified · 2014 — 2018
Interested in this professional?
Sign in as an employer to save this profile or invite Faith O. to a job.
Sign in as an employer