Nika Jean Sumobay
Surigao City
Summary
Detail-oriented Authorization Specialist with strengths in reviewing patient medical records to determine prior authorization needs. Manages submission of comprehensive authorization requests to insurance companies, ensuring timely follow-up and resolution. Focused on facilitating patient access to necessary treatments through diligent verification and problem-solving. Authorization Specialist skilled in investigating insurance denials. Coordinates verification of insurance coverage and eligibility, delivering accurate information for healthcare services. Committed to maintaining patient confidentiality while ensuring efficient communication with insurers.
Overview
1
1
Language
5
5
years of professional experience
Work History
Authorization Specialist
Valmed Philippines
02.2026 - Current
- Reviewing patient medical records to assess the need for prior authorization for treatments, procedures, or medications.
- submitting authorization requests to insurance companies, including all required documentation.
- Monitored authorization requests' status and followed up with insurance companies.
- Requested approval or denial letter from insurance once decision was finalised.
Authorization specialist
Enbrighten Solution
Antipolo
09.2021 - 02.2026
- Reviewing patient medical records to assess the need for prior authorization for treatments, procedures, or medications
- Verifying patient insurance coverage to ensure its accuracy and eligibility for proposed healthcare services.
- Preparing and submitting authorization requests to insurance companies, including all required documentation.
- Monitoring authorization requests' status and following up with insurance companies as needed.
- Investigating insurance denials and resubmitting requests or appealing when necessary to ensure patients receive necessary care.
- .
Verifying Benefits and Eligibility
Enbrighten Solution
Antipolo City
09.2021 - 02.2026
- Confirming patient insurance coverage, benefits, and eligibility before services are provided.
Education
Senior high School - Humanities and Social Sciences
Surigao del Norte National High School
Surigao City01-2019
Skills
- Patient interaction
- Medical confidentiality
- Insurance verification
- Prior authorization
- Problem solving
- Effective communication
- Time management
- Willingness to learn
- Active listening
Languages
English
Upper Intermediate
B2
Interests
- Listening to Music
- Dancing
Timeline
Authorization Specialist
Valmed Philippines
02.2026 - Current
Authorization specialist
Enbrighten Solution
09.2021 - 02.2026
Verifying Benefits and Eligibility
Enbrighten Solution
09.2021 - 02.2026
Senior high School - Humanities and Social Sciences
Surigao del Norte National High School