WALI SHAH

Medical Billing Specialist – Eligibility & Prior Authorizations

Accept • Full-time

Dec 2017 - Jul 2026 • 8 yrs 7 mos

Medical Billing Specialist with 8+ years of experience in U.S. healthcare revenue cycle management, specializing in Eligibility & Benefits Verification and Prior Authorizations. • Perform insurance eligibility and benefits verification for U.S. healthcare providers • Verify coverage, effective dates, deductibles, copays, coinsurance, out-of-pocket amounts, and patient responsibility • Review payer requirements for referrals, prior authorizations, pre-certifications, and pre-determinations • Submit and manage prior authorization requests and follow up with insurance payers • Track authorization status, approval/denial decisions, authorization numbers, and validity dates • Communicate with insurance companies and healthcare providers regarding coverage and authorization requirements • Review documentation to help ensure authorization requests meet payer requirements • Help identify coverage and authorization issues before services are provided, reducing billing delays and preventable denials • Maintain accurate documentation and follow HIPAA-aware workflows when handling patient information • Work with a dedicated team supporting credentialing, AR follow-ups, denial management, and payment posting Primary focus: Eligibility & Benefits Verification, Insurance Verification, Prior Authorizations, Pre-Certifications, Pre-Determinations, Referral Verification, and Authorization Follow-up.