I am a Medical Virtual Assistant with over four years of experience supporting U.S. healthcare providers in prior authorizations, insurance verification, referral coordination, and specialty pharmacy. Most recently, I worked with a busy rheumatology clinic using eClinicalWorks (eCW), where I managed medical benefit prior authorizations, appeals, predeterminations, insurance verification, referral processing, and patient scheduling. I have experience working with Medicare, BCBS, Anthem, UHC, UMR, Cigna, Aetna, Humana, Optum, Carelon, Availity, NovoLogix, and specialty pharmacies. I am comfortable communicating with providers, insurance companies, pharmacies, and patients to resolve authorization issues and coordinate treatment. I work independently, learn quickly, and take pride in accuracy, organization, and providing excellent support to healthcare teams.
Professional Experience
Memphis Arthritis Rheumatology Clinic (2026)
• Managed medical benefit prior authorizations for biologic and specialty medications including Actemra, Orencia, Benlysta, Cimzia, Prolia, Evenity, Jubbontti, Simponi Aria, Reclast, and Ilaris.
• Managed prior authorizations using eClinicalWorks (eCW) and payer portals, including Availity, NovoLogix, UHC, Carelon, and Optum.
• Prepared and submitted appeals, reconsiderations, predeterminations, letters of medical necessity, and supporting clinical documentation.
• Verified insurance eligibility, benefits, and authorization requirements for Medicare, BCBS, Anthem, UHC, UMR, Cigna, Aetna, Humana, and other commercial plans.
• Reviewed provider notes, laboratory results, DEXA scans, imaging, and clinical records to support medical necessity for specialty medications.
• Followed up with insurance companies to obtain authorization decisions, appeal outcomes, and case status updates.
• Coordinated incoming and outgoing referrals, scheduled new patient consultations, and communicated with referring providers regarding referral status.
• Contacted patients to schedule appointments, verify insurance information, discuss authorization updates, and coordinate treatment.
• Worked closely with physicians, nurse practitioners, infusion staff, specialty pharmacies, and insurance representatives to ensure timely patient care.
• Documented all patient interactions, insurance communications, and authorization activities in eClinicalWorks (eCW) while maintaining HIPAA compliance.
Tools used:
• eClinicalWorks (eCW)
• Availity
• NovoLogix
• UHC Provider Portal
• Optum
• Carelon
• Microsoft Office/Excel
• Google Workspace
Buwelo (An Exacstar Company) | Customer Service Representative & Prior Authorization Specialist (-----------)
Senderra Specialty Pharmacy (3 years)
• Processed and submitted high-volume prior authorization requests for specialty medications in compliance with insurance guidelines
• Coordinated with healthcare providers, pharmacies, and insurance carriers to obtain timely approvals
• Reviewed clinical documentation to ensure completeness and accuracy
• Followed up on pending requests, reducing approval delays
• Maintained detailed patient records while adhering to HIPAA and data privacy standards
Lexington Law Firm (1 year)
• Assisted clients in disputing inaccurate credit report information and offered tailored solutions. Handled customer communications across phone, email, and live chat, maintaining a high satisfaction rate
Exela Technologies Philippines | Data Encoder (-----------)
• Accurately entered and verified sensitive data across company databases.
• Maintained strict confidentiality and adherence to data privacy regulations
Tools used:
• eClinicalWorks (eCW)
• Availity
• NovoLogix
• UHC Provider Portal
• Optum
• Carelon
• Microsoft Office
• Google Workspace
Verified
