Prior Authorization Representative resume example with 14+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:

Personable and dedicated Psychology and Human Relations graduate having developed reliable professional skills offering an extensive career promoting positive interpersonal and human relations experiences. Considered an exceptionally demonstrative Human Relations professional with over 15 years of customer service experience which has allowed the active pursuit of assisting individuals in public assistance and service sector with enrollment and supportive services. Expert in assisting and managing eligibility information for members while offering an extensive education on policy interpretation, application and additional growth resources. Sparked by life as a Foster Mother, can be commonly seen displaying issue resolution expertise in fast past environments that are fair, compassionate and respectful with hope for change.

  • Strong demonstration of interpersonal, communication, customer service and organizational skills
  • Microsoft Office Suite Experienced
  • Critical Thinking and Decision Making
  • Outstanding Work Ethics
  • Attentive and Detail-Orientated
  • Leadership and Training
  • Conflict Resolution
Prior Authorization Representative, 05/2022 to Current
Bioplus Specialty PharmacyTX, State,
  • Followed all Medicare, Medicaid, HIPPA and private insurance regulations and requirements.
  • Maintained high level of professionalism and interpersonal skills when speaking to patients, doctors and insurance companies.
  • Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Used Microsoft Office, IRIS to input claim, prior authorization and other important data into system.
  • Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
Eligibility Specialist, 06/2008 to 05/2021
Housing Authority Of The County Of Salt LakeSalt Lake City, UT,
  • Processed benefits applications and documents Application for receipt of State and Federally funded programs such as Medicaid, Food Stamps and Cash Assistance
  • Interviewed potential clients, collecting personal information to determine eligibility for social assistance.
  • Analyzed information from interviews, educational and medical records, consultation with other professionals and diagnostic evaluations to assess clients' abilities, needs and eligibility for services.
  • Proficient in high volume telephone call handling (Inbound & Outbound Calls) with special attention to escalation processes.
  • Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
  • Managed intake of new claims and performed routine re-determinations.
  • Coordinated with other departments to promote prompt processing of client applications.
  • Connected individuals with relevant community resources and coordinated referrals.
  • Worked closely with disabled or impoverished individuals to locate helpful financial resources and community programs.
  • Maintained accurate records and documented client data in company databases to prevent data compromise and comply with HIPAA regulations.
  • Built and maintained strong relationships with patients by successfully resolving issues and responding promptly to phone inquiries.
Customer Service Representative, 04/2007 to 05/2008
Quipt Home MedicalNorfolk, VA,
  • Demonstrated excellent communication skills in resolving product and consumer complaints by resolving with knowledgeable and friendly service.
  • De-escalated problematic customer concerns by remaining calm and professional in stressful circumstances and effectively diffusing tense situations.
  • Maintained knowledge of current promotions, exchange guidelines, payment policies and security practices.
  • Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions encouraging repeat business.
  • Exceeded company productivity standards on consistent basis.
Education and Training
Bachelor of Science: Psychology And Human Relations, Expected in 04/2022
Indiana Wesleyan University - Marion, IN,

GPA: 3.1 Course work includes: Psychology, Sociology, Organizational Psychology, Developmental Psychology, Social Problems, Interview Skills in Human Services, Interpersonal Communication, Relationship Development, Research Methods in Applied Psychology, Techniques in Motivation, Abnormal Behavior, Statistics in Social Science

Associate of Science: Liberal Arts And General Studies, Expected in 04/2019
Indiana Wesleyan University - Marion, IN

GPA: 3.6, Course work includes College Writing, American History, Literature, Sociology, Biblical Studies, Interview Skills, Interpersonal Communication and Anatomy with a concentration in Psychology, Developmental Stages and Organizational Social Structure

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Resume Overview

School Attended

  • Indiana Wesleyan University
  • Indiana Wesleyan University

Job Titles Held:

  • Prior Authorization Representative
  • Eligibility Specialist
  • Customer Service Representative


  • Bachelor of Science
  • Associate of Science

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