At ScribeEMR Pvt. Ltd, I managed prior authorization workflows for specialty pharmaceuticals, chronic disease medications, and diagnostic procedures. I reviewed clinical documentation, ICD-10 codes, and payer medical-necessity criteria for submissions.
I investigated insurance coverage and formulary restrictions, analyzed denials, and coordinated appeals and resubmissions with providers, case managers, and patients.
Across my prior authorization work, I managed over 2,500 authorizations with an 88% first-pass approval rate. I also trained and mentored five junior team members on payer guidelines and workflows.
Previously, as a Virtual Radiology Assistant at Connected Value Health Service Pvt. Ltd, I reviewed and verified imaging cases for U.S. radiologists and prepared patient histories and medical documentation. I use MEDENT EHR, CoverMyMeds, payer portals, Excel, and SQL in healthcare operations work.
