Marlyn M.
Mid-Level Healthcare Prior Authorization Specialist
Open to offersNew to PlatformAbout
Marlyn M. is a dedicated healthcare support professional with expertise in prior authorization, insurance verification, and payer coordination, focusing on U.S.-based healthcare sectors like Sleep Medicine and Durable Medical Equipment (DME). While serving at 3Y Health, Marlyn effectively managed high-volume ABA prior authorization requests for both Medicaid and commercial insurance, ensuring timely approval of behavioral health services. Her role at Strategic Office Support involved supporting sleep diagnostic processes and managing end-to-end authorization workflows, where she verified insurance coverage and spearheaded documentation processes. Marlyn's knowledge extends to maintaining accurate Electronic Health Records (EHR) and complying with HIPAA regulations. Further broadening her skills, she has experience in customer service with EXL Service and Teleperformance, and administrative roles in the real estate industry, thus demonstrating her capacity to adapt and perform in diverse professional environments.
Experience
Prior Authorization Specialist
3Y Health · 2025 — 2026Handled a significant volume of ABA prior authorization and reauthorization requests for Medicaid and commercial insurance plans. Reviewed payer requirements and verified authorization criteria while coordinating submissions for behavioral health services approvals. Collaborated with BCBAs, caregivers, clinical teams, and insurance representatives on authorization requests and resolved issues regarding documentation and follow-ups. Prepared and tracked essential clinical documentation, including treatment plans and diagnostic evaluations, through authorization platforms and payer portals. Actively monitored pending authorizations and maintained records to address payer-related issues.Healthcare Associate
Strategic Office Support · 2023 — 2025Provided support to two healthcare providers focused on sleep diagnostics and DME, specifically enhancing the HST, PSG, MSLT, and PAP titration sleep-study processes. Conducted verification of insurance eligibility and benefits for both sleep studies and DME. Managed the entire prior authorization workflow process, which included documentation preparation, payer submissions, and tracking status of approvals and denials. Processed incoming faxes for patient records and created new patient profiles in the EHR. Reviewed patient and physician documentation for accuracy, submitted clinical documentation through payer portals, and maintained organized medical records.Resume Formatter - Seasonal
EMAPTA · 2022 — 2022Edited and structured resumes to enhance readability and alignment with client specifications. Tailored resumes according to candidates’ backgrounds and targeted roles.Customer Service Associate
EXL Service · 2020 — 2022Assisted members of Aetna Behavioral Health by coordinating with licensed therapists through the Employee Assistance Program. Facilitated access for members to behavioral health services by collaborating with healthcare providers. Addressed inquiries related to benefits, including Health Savings Accounts and other associated concerns.Customer Service Representative
Teleperformance · 2018 — 2020Delivered customer support and technical assistance for a home security system account. Addressed account issues, troubleshooting problems, and processing service requests while adherently maintaining quality standards.Administrative Assistant
Fuente Triangle Realty Development Corporation · 2014 — 2018Supported operations within real estate and property development through document preparation and transaction coordination. Handled the preparation and processing of property contracts and legal documents while ensuring organized records. Aided billing and collections by managing Statements of Account and maintaining transactional accuracy.
Skills & Expertise
Education
- Bachelor of Science in Information SystemsUniversity of Cebu – Banilad Campus
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