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Medical Authorization Specialist Resume Example

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JC
Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000, resumesample@example.com
Professional Summary
Prior Authorization Specialist with 8 years experience in the medical field.  Excellent communication and customer service skills.  Detail-oriented and focused on accuracy and efficiency.
Skill Highlights
  • Knowledge of ICD10 codes/CPT codes
  • Excellent communication and customer service skills
  • Bilingual in Spanish/English
  • HIPAA trained
  • Medical terminology knowledge 
  • Proficient in Microsoft Windows, Office, Word, Outlook, Power Point and Excel
Professional Experience
07/2015 to Current Medical Authorization Specialist Bioventus | Miami, FL,
  • Obtain authorizations from health insurance, worker's comp, amongst other payors for MRI, CT and NUC MED.
  • Update patient demographics and insurance information.
  • Daily interaction with other departments to assist patients and providers with problems or questions and act as a facilitator to resolve questions or concerns.
09/2010 to 05/2016 Pharmacy Service Associate Lincare | Duluth, GA,
  • Assisted providers initiating and completing prior authorizations for patient medications.
  • Provided customer service to members, providers and pharmacist with authorizations status, reconsiderations, appeal process, and medication overrides.

Customer Service Rep

  • ​Educated Spanish/English speaking members  on how to take advantage of their benefits in a fast paced environment.
  • Provided claim status to members and providers.
  • Researched issues and provided resolutions if applicable.
  • Provided medical/dental benefit details to members and providers.
  • Enrolled new members and made changes to existing medical/dental plans.
10/2007 to 09/2010 RX Enrollment Specialist Humana Healthcare | City, STATE,
  • Acted as a facilitator for members in resolving questions or concerns regarding their medications.   
  • Provided customer service to members with prescription refills.
  • Outbound soft sales calls.
  • Assisted with delegated agents calls with data entry.

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Resume Overview

School Attended
    Job Titles Held:
    • Medical Authorization Specialist
    • Pharmacy Service Associate
    • RX Enrollment Specialist
    Degrees

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