P
Priyanka Jha
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Woodbridge, Virginia, United States
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- LPrior Authorization SpecialistLocal Infusion CenterJan 2024 - Current (2 years 9 months)• Perform end-to-end prior authorization for infusion and specialty medications aligning
payer policies with ICD-10 and HCPCS/J-codes
• Conduct detailed benefits verification including deductible, co-insurance, and out-of-
pocket analysis
• Review payer medical policies to determine authorization requirements and prevent
delays or denials
• Coordinate with providers to obtain clinical documentation supporting medical necessity
• Communicate with insurance payers to resolve authorization issues
• Ensure financial clearance prior to infusion scheduling
• Maintain HIPAA-compliant documentation in EMR systems 
Care Coordination & Authorization SupportGastro HealthJan 2022 - Jan 2024 (2 years 1 month)• Managed insurance verification, scheduling, and pre-registration
• Supported prior authorization workflows and payer communication
• Assisted UM nurses with documentation and case preparation- VCase InvestigatorVirginia Department of Health – Loudoun CountyJan 2021 - Jan 2022 (1 year 1 month)• Conducted intake interviews and collected health and insurance information
• Documented cases in NEDSS and ensured accurate public health reporting
• Coordinated with schools and health teams for case resolution and follow-up - Contact TracerVirginia Department of HealthJan 2020 - Jan 2021 (1 year 1 month)• Conducted telephonic interviews to collect health, exposure, and insurance-related data
• Provided guidance and education while maintaining HIPAA compliance
• Documented case information accurately for public health tracking systems