SHINE SHARMA

• Verified insurance coverage details by conducting calls and utilizing websites efficiently.
• Obtained prior authorization information from insurance companies before procedures and tests.
• Created authorizations through direct communication with payers and online platforms.
• Utilized operational tools such as Athena Web, Avality Web, R1hub, and Epic.

• Verified patient eligibility and benefits to establish service authorization requirements.
• Initiated authorizations through calls, mail, and online platforms for expedited processing.
• Faxed clinical documentation to secure necessary authorizations and ensure prompt approvals.
• Conducted follow-ups to confirm timely processing of authorization requests.
• Provided guidance on next steps for clients with denied cases to facilitate resolution.

Clarified authorization processes to enhance client understanding.

• Streamlined communication channels, optimizing efficiency in handling authorizations.
• Demonstrated proficiency with healthcare websites including Cigna, Carelon, and UHC.