Medical Virtual Assistant and Prior Authorization Specialist with over four years of experience supporting U.S. healthcare organizations, including specialty pharmacy and rheumatology. Experienced in medical and pharmacy benefit prior authorizations, insurance verification, appeals and reconsiderations, predeterminations, referral coordination, patient scheduling, and clinical documentation review. Skilled in coordinating with providers, pharmacies, insurance carriers, and patients to resolve authorization issues and support timely access to treatment.
CORE SKILLS
• Prior Authorization Processing • Insurance Verification & Benefits Coordination • Medical & Pharmacy Benefits • Specialty Pharmacy Support • Appeals & Reconsiderations • Predeterminations • Medical Necessity • Clinical Documentation Review • Referral Coordination • Patient Scheduling • Copay Assistance • Provider & Payer Communication • HIPAA Compliance
Professional Experience
Memphis Arthritis Rheumatology Clinic | Medical Virtual Assistant / Prior Authorization Specialist (Independent Contractor) | April 2026 – July 2026
• Managed medical benefit prior authorizations for biologic, infusion, and specialty medications
• Submitted and tracked prior authorizations through eClinicalWorks (eCW) and payer portals including Availity, NovoLogix, UHC, Optum, and Carelon.
• Reviewed provider notes, laboratory results, DEXA scans, imaging, medication history, and clinical records to support medical necessity.
• Prepared and submitted appeals, reconsiderations, predeterminations, letters of medical necessity, and supporting clinical documentation.
• Verified eligibility, benefits, and authorization requirements for commercial and Medicare insurances
• Coordinated referrals and patient scheduling, communicated authorization updates, and documented payer and patient interactions in eCW while maintaining HIPAA compliance.
Senderra Specialty Pharmacy | Prior Authorization Specialist | July 2022 – October 2025
• Processed and submitted high-volume prior authorization requests for specialty medications in accordance with insurance guidelines.
• Reviewed clinical documentation for completeness and accuracy and coordinated with healthcare providers, pharmacies, and insurance carriers to obtain timely authorization decisions.
• Supported specialty practices including dermatology, rheumatology, gastroenterology, ophthalmology, etc.
• Followed up on pending requests and assisted with reconsiderations, appeals, and copay or patient support program enrollment when applicable.
• Maintained detailed patient and authorization records while adhering to HIPAA and data privacy requirements.
Lexington Law Firm | Customer Service Representative | June 2021 – July 2022
• Assisted clients with disputes involving inaccurate credit report information and handled customer communication across phone, email, and live chat.
Exela Technologies Philippines | Data Encoder | 2015–2021
• Accurately entered, reviewed, and verified confidential data across multiple systems in high-volume workloads.
• Maintained strict confidentiality and compliance with data privacy requirements.
