Professional Summary
Hi! I'm Anabelle Fallaria, a healthcare professional with over 3 years of combined U.S. healthcare experience specializing in Medication Prior Authorization and Patient Services. Strong knowledge of payer guidelines, insurance requirements, and member support, developed through hands-on remote work in fast-paced, compliance-driven environments. In addition to healthcare, I also bring over 10 years of experience in other industries, engaging directly with customers and strengthening my communication, problem-solving, and service skills.
In my Prior Authorization experience, which is my most recent role, I have worked remotely for over 2 years managing end-to-end prior authorization processes for U.S. healthcare accounts on the payer/PBM side. My responsibilities include reviewing payer requirements, building prior authorization cases from fax requests received from doctor’s offices, verifying patient eligibility and benefits, gathering and analyzing clinical documentation, and coordinated with providers, internal resolution teams, and clinician for case review and escalation as needed.. I have handled routine, complex, and urgent STAT requests, ensuring proper prioritization based on clinical urgency and payer-specific guidelines while maintaining strict HIPAA compliance, documentation accuracy, and workflow efficiency.
In my Patient Services experience, I provided direct support to members and patients by processing prescription refills, handling order status inquiries, tracking medication deliveries, and managing payment and credit balance concerns. I delivered accurate, empathetic, and solution-focused assistance regarding insurance coverage, medication access, pharmacy benefits, and plan details. I also supported providers with eligibility and coverage verification, ensuring smooth coordination across members, pharmacies, and healthcare plans while maintaining compliance with HIPAA and payer guidelines. This role strengthened my communication, problem-solving, and customer service skills while deepening my understanding of the patient journey within the U.S. healthcare system.
Why Work With Me
I bring a strong combination of prior authorization expertise and patient-facing healthcare experience, allowing me to understand both operational workflows and member needs in a healthcare setting. I am highly organized, detail-oriented, and dependable in high-volume, accuracy-critical environments. I work efficiently in remote setups, adapt quickly to new systems and workflows, and consistently maintain strong performance with minimal supervision. I am committed to delivering accurate, timely, and compliant results while ensuring a positive, professional, and supportive experience for both patients and healthcare partners.
