Open to opportunities

tara edwards

@taraedwards1

I’m a detail-focused prior authorization specialist improving healthcare approvals through accurate documentation and payer coordination.

United States

Message

What I'm looking for

I’m looking for a remote role where accuracy and HIPAA compliance matter—processing prior authorizations efficiently, collaborating with providers and payers, and improving turnaround times through strong documentation and follow-up.

I process prior authorization requests for medications, imaging, procedures, and specialty services, making sure submissions are timely and accurate. I verify insurance eligibility, benefits, and payer-specific authorization requirements across commercial, Medicare, and Medicaid plans, while reviewing clinical documentation for completeness and medical necessity.

In my roles supporting healthcare operations, I coordinate with providers, nurses, pharmacies, and payers to resolve delays and clarify requirements. I track and follow pending authorizations in EMR/EHR systems and authorization portals, support appeals and denials, and contribute to workflow improvements—maintaining compliance with HIPAA and organizational standards while managing high-volume, remote case work.

Experience

Work history, roles, and key accomplishments

Current

Remote Prior Authorization Specialist

Current

Centene

Dec 2023 - Present (2 years 8 months)

Process prior authorization requests for medications, imaging, procedures, and specialty services. Verify insurance eligibility/benefits, review clinical documentation for completeness and medical necessity, coordinate with providers and payers, and track pending authorizations in EMR/EHR and authorization portals.

Prior Authorizations Clinical Documentation Review EMR EHR Systems HIPAA compliance High Volume Data Entry CPT

Insurance Verification & Auth Support

Sarvona

Jul 2020 - Nov 2023 (3 years 4 months)

Conduct insurance eligibility checks and verify coverage for scheduled services and procedures. Determine prior authorization requirements, coordinate with providers for missing documentation, review coding accuracy (CPT/ICD-10/HCPCS), and support calls, appeals, and denial follow-ups.

Prior Authorizations Clinical Documentation Review High Volume Data Entry CPT HIPAA compliance

Healthcare Administrative

East Mississippi Medical Clinic

Aug 2017 - Jun 2020 (2 years 10 months)

Respond to patient inquiries related to insurance, coverage status, and next steps while managing confidential healthcare documentation in line with HIPAA requirements. Support scheduling and clinical workflows through accurate data entry, case updates, and electronic file management.

HIPAA compliance Patient Communication Data Entry File Management Scheduling Support

Education

Degrees, certifications, and relevant coursework

Blue Cliff College

Associate degree, Medical Administration & Medical Coding/Billing

Activities and societies: Relevant coursework: Medical Terminology, Health Insurance, Medical Coding & Billing. Certifications listed: Certified Prior Authorization Specialist (CPAS), Certified Medical Administrative Assistant (CMAA), CPC-A/billing-coding certification, HIPAA compliance certification, and medical billing/coding training.

Earned an associate degree focused on healthcare administration topics including medical terminology, health insurance, and medical coding and billing.