Muhammad Salman

Team Lead, Prior Authorization

TBC Solutions • Full time

Dec 2022 - Present • 3 yrs 10 mos

Lead the prior authorization team for a US knee pain and interventional radiology group, working US Eastern hours. - Own prior authorizations for Genicular Artery Embolization, pain management procedures, viscosupplements (Euflexxa, Durolane, Gelsyn, Supartz FX, Hyalgan), Zilretta, cortisone and knee braces - Verify eligibility and benefits before each authorization, by portal and by phone - Work 20 to 30 authorization cases a day at a 90 to 95 percent approval rate, with most requests submitted within 24 to 36 hours - Take denials through first and second level appeal, and obtain out-of-network approvals through Single Case Agreements - Handle referral authorizations with PCP offices, and Medicaid plan cases - Built the team's authorization tracker (status, expirations, follow-up dates), code reference sheet, templates and SOPs - Portals: Availity, UHC/Optum, Aetna, Cigna, Humana, NovoLogix, CoverMyMeds, CareAffiliate Before leading the team I worked as PA Specialist and Team Coordinator on viscosupplement, Zilretta and cortisone authorizations across multiple practices.

Prior Authorization Specialist

Activekey Solutions • Full time

Mar 2019 - Dec 2022 • 3 yrs 9 mos

Prior authorization work for specialty knee osteoarthritis medications, supporting US practices. - Obtained prior authorizations for knee osteoarthritis injectable medications - Specialty pharmacy support: ran test claims on the pharmacy benefit to confirm patient copay before dispatch - Tracked specialty medications until they were delivered to the provider's office