Catona Porter
Nashville
Summary
Detail-oriented Prior Authorization Specialist skilled in HIPAA compliance, clinical documentation review, and data analysis. Enhances workflow efficiency and expedites authorization processing. Collaborates with providers and clinical teams to optimize operations and elevate customer satisfaction.
Overview
8
8
years of professional experience
Work History
Prior Authorization Specialist
Centene
Nashville
07.2023 - Current
- Process and review Medicaid prior authorization requests while ensuring compliance with state and federal guidelines.
- Evaluate clinical documentation for completeness, accuracy, and medical necessity requirements.
- Coordinate with healthcare providers, case managers, and clinical staff to obtain required documentation and facilitate timely determinations.
- Maintain accurate authorization records and documentation in accordance with HIPAA and organizational standards.
- Analyze authorization trends and identify opportunities to improve workflow efficiency and reduce processing delays.
- Support quality assurance initiatives by monitoring accuracy and compliance throughout the authorization process.
- Consistently manage a high-volume workload while meeting productivity and turnaround-time expectations.
Senior Account Specialist
SMILE DIRECT CLUB
NASHVILLE
08.2018 - 11.2023
- Managed complex customer accounts and escalated case resolutions within a healthcare-focused environment.
- Collaborated with clinical, operational, and executive teams to resolve service issues and improve patient satisfaction.
- Analyzed account trends and workflow data to identify process improvement opportunities.
- Maintained accurate records and documentation to support operational compliance and service quality.
- Coordinated multiple projects while ensuring timely completion and adherence to organizational standards.
Benefits Verification Specialist
UNUM
Nahville
07.2022 - 07.2023
- Evaluated medical records and documentation to assess benefit eligibility and expedite claims processing.
- Managed end-to-end administration of Short-Term Disability (STD) and FMLA claims.
- Applied ICD-10 codes and regulatory guidelines to ensure accurate claim processing.
- Partnered with healthcare providers, employees, and HR representatives to gather necessary documentation and swiftly address claim issues.
- Provided timely communication and effective case resolution to enhance customer satisfaction and support claimants.
- Maintained strict confidentiality and compliance with healthcare regulations while working in a remote environment.
Education
High School Diploma -
Nashville School of The Arts
Nashville, TN05-2012
Skills
- Compliance management
- Clinical documentation review
- Authorization processing
- Data analysis
- Case coordination
- Customer account management
- Prior Authorization Platforms
- Medicaid Management Systems
- ICD-10 Coding
- Electronic Medical Records (EMR/EHR)
- Microsoft Excel
- Microsoft Word
- Outlook
- Data Entry & Documentation
- Case Management Systems
- Healthcare Claims Processing
- HIPAA Compliance
Timeline
Prior Authorization Specialist
Centene
07.2023 - Current
Benefits Verification Specialist
UNUM
07.2022 - 07.2023
Senior Account Specialist
SMILE DIRECT CLUB
08.2018 - 11.2023
High School Diploma -
Nashville School of The Arts