Muhammad I

@nasirirshaad

Prior Authorization and Insurance Verification Specialist US Healthcare

Pakistan
English, Urdu
About me
I am a dedicated Medical Authorization & Verification of Benefits (VOB) Specialist with 4+ years of leadership experience. Skilled in high‑acuity pain management procedures (ESI, MBB, RFA, SCS, PNS) and proficient in eClinicalWorks, NextGen, and PEHR. I ensure 100% accuracy, HIPAA compliance, and efficient workflow optimization. With a reliable home office setup, I deliver detail‑oriented remote support that helps healthcare practices achieve smooth billing and compliance operations.... Read more

Skills

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nasirirshaad
Muhammad I
Offline • 
Average response time: 1 hour

See my services

General Assistance
I will do medical prior authorization and insurance eligibility verification vob
From$10 / projectMore details

Portfolio

Work experience

Advanced_Healthcare Staffing Solutions

Team Lead (Medical Authorization)– Advanced Healthcare Solutions

Advanced Healthcare Staffing Solutions

Mar 2024 - Sep 2026 • 2 yrs 6 mos

Complex Authorization Management Expertly secured prior authorizations for high‑acuity interventional pain procedures (ESI, MBB, RFA, SCS, PNS). Reduced peer‑to‑peer review requirements by auditing documentation against payer guidelines. Verification of Benefits (VOB) Conducted comprehensive eligibility checks for Durable Medical Equipment (DME) and Urine Toxicology (Utox). Accurately identified patient responsibility and coverage limits to prevent front‑end denials. EHR Mastery Managed high‑volume data entry and documentation in eClinicalWorks (eCW), NextGen, and PEHR. Maintained 100% accuracy in patient records and authorization status. Denial & Appeals Leadership Led resolution of denied claims through clinical appeals and direct payer coordination. Consistently overturned rejections, protecting hospital revenue and patient care. Compliance & Quality Assurance Monitored adherence to HIPAA and CMS standards. Conducted regular chart reviews to correct documentation errors and ensure compliance.

Ascend_BPO Services

Medical Authorization & Verification Specialist

Ascend BPO Services

Apr 2022 - Feb 2024 • 1 yr 10 mos

Experienced in managing complex authorization workflows for high‑acuity interventional pain management and surgical procedures (ESI, MBB, RFA, SCS, PNS). Skilled in conducting comprehensive Verification of Benefits (VOB) and eligibility checks for Durable Medical Equipment (DME) and pump treatments (trial, implant revision, and replacement). Proficient in EHR systems including eClinicalWorks (eCW) and ensuring 100% accuracy in patient records and strict HIPAA compliance. Adept at resolving denied claims through clinical appeals, coordinating directly with insurance providers, and maintaining CMS regulatory standards. Recognized for improving approval turnaround times and reducing front‑end denials through meticulous documentation, workflow optimization, and proactive payer communication.