Mark Lester Antonio Registered Nurse

Prior Authorization Specialist

Medcore Solutions

Jun 2025 - Mar 2026 (10 months)

• Obtain PA request from provider via payer portal, fax, or phone. • Verify completeness of required information (patient details, CPT/ICD-10 codes, ordering/servicing provider. • Verify patient eligibility and benefits and confirm active coverage. • Check benefits plan coverage limitations, and PA requirements. • Review payer guidelines to confirm authorization requirements. • Identify if request is urgent or standard. • Collect relevant medical records (progress notes, labs, imaging, treatment history) • Ensure documentation supports medical necessity for claims processing.

N

Staff Nurse 1

Nueva Ecija Medical Center

Jul 2023 - Aug 2024 (1 year 2 months)

• Triage: assessing the severity of patient's conditions and prioritizing the care. • Patient care: administering medications, performing wound care, starting IV lines, and monitoring vital signs. • Documentation: keeping accurate records of patient care, treatments, and progress. • Patient Education: explaining diagnoses, treatments, and follow-up care to patients and their families. • Equipment management: ensuring that electronic medical records are well maintained.

A

Management Trainee

Access Health Care, Philippines

Nov 2019 - Mar 2023 (3 years 5 months)

• Worked closely with other team leaders, quality team, and agents to provide high-quality standards for health based on ISO standards of health care. • Create action plans that contribute big impact in the improvement of baseline processes. • Basic support on the workflows to the team. • Upskilling team members for their growth.

A

Quality Analyst

Access Health Care, Philippines

May 2017 - Nov 2019 (2 years 7 months)

• Quality check of daily process from the operations. • Weekly calibration. • Revision of workflow with the training team as necessary. • Work and support the operations for process improvement. Negotiate with vendors, plan and propose workflows.

A

Client Specialist

Access Health Care, Philippines

Jan 2016 - May 2017 (1 year 5 months)

• Obtain benefits and eligibility for all medical, surgical, pharmaceutical, and DME services. • Provide service for multiple clients per day for both website and outbound calls. • Provide benefits and eligibility for most US coverage for both commercial and federal insurance. • Obtain prior authorization for medical, surgical, DME and pharmacy from both commercial and federal insurance. • Review patient clinicals and provide accurate information to the insurance to obtain 100% approval of the procedure being requested by the provider. • Ensuring electronic medical records are in place. • Navigating MS forms, MS excel, MS teams, Athena Health EMR, Zoom, Citrix, BCBS all states, Aetna, Humana, Tricare, Medicare, Medicaid, UHC, Ambetter healt

Mark Lester Antonio

About

Detail

Timeline

Résumé