Open to opportunities

Heidi Medina

@heidimedina

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Patient Support Advocate skilled in remote insurance coordination, medication approvals, and prior authorization.

United States

Message

What I'm looking for

I’m looking for a remote role where I can coordinate insurance and prior authorizations, adjudicate medication and benefit claims accurately, and use EHR workflows to improve patient outcomes and continuity of care.

I’m a Patient Support Advocate with experience facilitating medication approvals by directly communicating with insurance companies, navigating pharmacy operating systems, and adjudicating test claims. I document patient concerns and prior authorization status across electronic medical records and email, then create action plans for follow-up while maintaining complete, accurate communication records.

Previously, I served as a Transplant Benefit Specialist, interpreting complex transplant benefit policies and evaluating member eligibility for solid and bone marrow transplants in line with state and federal regulations. I also bring a strong clinical and workflow foundation from my roles as a Clinical Pharmacy Technician II and a Specialty Resolution Specialist, supported by my PTCB certification and Florida Registered Pharmacy Technician credential.

Experience

Work history, roles, and key accomplishments

Patient Support Advocate

Shields Health Solutions

Dec 2025 - Apr 2026 (4 months)

Communicated with insurance companies to facilitate medication approvals and performed pharmacy operating system data entry and test-claim adjudication. Documented prior authorization status, financial assistance needs, and patient concerns while coordinating with pharmacists and pharmacy liaisons.

Prior Authorizations Pharmacy Claim Adjudication Electronic Medical Records (EMR)Medical Documentation HIPAA compliance

Transplant Benefit Specialist

Anthem

Feb 2022 - Nov 2025 (3 years 9 months)

Reviewed and interpreted complex transplant benefit policies to support accurate claims and eligibility determinations for solid and bone marrow transplants. Educated members and providers on coverage details, cost-sharing, out-of-network implications, and Center of Excellence participation while maintaining detailed case documentation.

Transplant Benefits Analysis Insurance Verification Claims Eligibility Determination Claims Documentation

Clinical Pharmacy Technician II

Anthem

Oct 2020 - Feb 2022 (1 year 4 months)

Interviewed patients to collect comprehensive medication histories, documented questions for pharmacist follow-up, and recommended formulary alternatives to physicians and patients. Provided specialized support for conditions including diabetes, asthma, high cholesterol, and high blood pressure.

Medication History HIPAA compliance Patient Communication

Specialty Resolution Specialist

Walgreens

Aug 2015 - Oct 2020 (5 years 2 months)

Resolved third-party rejects for specialty medications by reviewing information, correcting submission data, and resubmitting for plan-required processing. Processed and reviewed over 200 prescriptions daily with accuracy while investigating rejected claims and verifying prior authorization status with physician offices and health plans.

Prescription processing Claims Research Quality Assurance

Education

Degrees, certifications, and relevant coursework

Universidad Ana G. Méndez

Associate of Science, Science

Grade: summa cum laude

Activities and societies: Certifications: Pharmacy Technician Certification Board (PTCB), Registered Pharmacy Technician (Florida), Precision Nutrition Certification.

Earned an Associate of Science degree from Universidad Ana G. Méndez in 2012, graduating summa cum laude. Also holds pharmacy-related certifications including PTCB certification, Registered Pharmacy Technician (Florida), and Precision Nutrition.