Jasmine Maya

Educate and enroll Medicare recipients into Medicare Advantage and Medicare Supplement plans adhering to strict CMS compliance guidelines. Analyze member coverage requirements and pharmacy benefits to deliver tailored health plan guidance and resolve complex inquiries.

Verified primary and secondary insurance coverage and populated patient account demographics to maximize clean-claim submission rates. Processed complex workers' compensation and TRICARE claims; audited documentation to maintain strict compliance with payer rules.

Fielded high-volume member and pharmacy benefit inquiries concerning Medicare prescription access, tiers, and copay structures. Collaborated directly with physicians and health plan sponsors to streamline coverage verifications and expedite patient access to specialty drugs.

Partnered with clinical care teams to confirm coverage limitations, eligibility, and pre-requisites prior to dispensing high-cost specialty orders. Served as primary liaison between patients, clinical providers, and insurance payers to resolve eligibility roadblocks and minimize claim denials.

Resolved complex billing inquiries, processed payment adjustments, and supplied technical support across high-volume customer touchpoints. Maintained rigorous CRM data accuracy while collaborating across specialized cross-functional teams to resolve client escalations.

Supervised a team of 12–18 prior authorization specialists; monitored daily call queues, audited performance metrics, and led individual coaching. Managed escalated cases, ensuring rapid review of urgent medication and procedure authorization requests across EHR systems.

Evaluated prior authorization requests for commercial, Medicaid, Medicare, and TRICARE beneficiaries. Utilized DEERS to verify military benefits and compiled clinical notes to support medical necessity criteria for government payers.

Bachelor of Science in Business Administration from the University of Cincinnati.

High school diploma from William Mason High School, graduated in June 2011.