Mohammad A

Prior Authorization Specialist

CVS Health • Full time

Jun 2022 - Present • 4 yrs 2 mos

Insurance Verification & Revenue Cycle Management Specialist 4+ years of experience in US Healthcare Revenue Cycle Management, specializing in Insurance Verification, Eligibility & Benefits Verification, Prior Authorization, Claims Review, Denial Management, and Provider Communication. Experienced in verifying patient insurance coverage, benefits, deductibles, copays, coinsurance, out-of-pocket details, network status, and authorization requirements. Skilled in working with US insurance portals, EMR/EHR systems, payer guidelines, and healthcare documentation. Specialties Supported: • Orthopedics • Oncology • Immunology • Ophthalmology / Ocular Care • Primary Care • Specialty Clinics Key Achievements: • Managed high-volume insurance verification and authorization requests accurately. • Identified coverage and authorization requirements before services were provided. • Handled denials, follow-ups, escalations, and provider communication. • Experienced with ICD-10, CPT, and HCPCS codes. • Maintained accurate documentation while following HIPAA-compliant processes.