Ariel Alton
Saint Louis
Summary
Detail-oriented professional with expertise in claims processing, regulatory compliance, and problem-solving. Proven ability to enhance healthcare coordination and resolve issues efficiently, ensuring accurate and timely service delivery. Also a known dedicated Health Plan Specialist skilled in medical and pharmacy prior authorizations with effective communication. Has demonstrated success in collaborating with providers and members to streamline processes and resolve issues, contributing to improved service outcomes and member satisfaction. Along with problem solving and team collaboration by being proactive and professional with a strong background in healthcare coordination and claims analysis.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Health Plan Specialist
Medica
Saint Louis
11.2025 - Current
- Assisted members in understanding health plan options and benefits.
- Coordinated with providers to facilitate accurate claims processing, enhancing member satisfaction.
- Processed member inquiries and resolved issues promptly, improving service quality.
- Maintained up-to-date knowledge of healthcare regulations and policies.
- Collaborated with team members to enhance service delivery processes.
- Reviewed and analyzed health care claims to identify discrepancies and prevent fraud.
Prior Authorization Specialist
Anthem
Saint Louis
09.2021 - 10.2025
- Processed prior authorization requests for medical procedures and services.
- Assessed clinical documentation to determine medical necessity for authorization approvals.
- Communicated with healthcare providers regarding authorization status and requirements.
- Utilized electronic systems to track and manage authorization workflows.
- Instructed providers on authorization guidelines and submission processes to ensure compliance.
- Maintained accurate records of all prior authorization communications and decisions.
- Verified patient insurance coverage, including eligibility and benefits, to facilitate timely authorizations for medical services.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Notified ordering providers of denied authorizations.
Technical Support Representative
Charter Spectrum
Bridgeton
09.2016 - 09.2021
- Provided technical support for customer inquiries via phone and chat.
- Diagnosed and resolved issues with internet and phone services.
- Documented customer interactions in the company's CRM system accurately.
- Collaborated with engineering teams to resolve network outages, minimizing downtime for customers.
- Educated customers on product features and troubleshooting techniques to enhance user experience.
- Escalated complex issues to appropriate departments for further assistance promptly.
- Troubleshot customer inquiries related to software and hardware issues.
- Assisted customers with various types of technical issues via email, live chat, and telephone.
- Documented all activities related to technical support including processes, updates, changes made.
- Delivered remote assistance for technical issues through screen sharing and control tools, ensuring timely resolutions.
Certified Nursing Assistant
Missouri Baptist Hospital
Saint Louis
03.2013 - 09.2016
- Provided assistance with daily living activities and personal hygiene, enhancing patient comfort and dignity.
- Provided assistance with activities of daily living, including bathing, dressing and grooming.
- Monitored vital signs and reported changes to nursing staff.
- Performed vital sign assessments, such as taking blood pressure and temperature.
- Collaborated with nurses to provide medications and treatments.
- Responded promptly to patient calls for assistance, ensuring timely support for individual needs.
- Communicated effectively with patients, families, and healthcare team members.
- Documented patient care activities in electronic health records, maintaining accurate and up-to-date patient information.
- Documented patient care services by charting in designated areas.
- Maintained cleanliness and safety of patient rooms and common areas.
- Trained new staff on patient care protocols and hospital procedures.
Education
High School Diploma -
Pattonville High School
Maryland Heights, MO05-2011
Some College (No Degree) - Nursing
Florissant Valley Community College
Saint Louis, MOSkills
- Claims processing
- Health plan analysis
- Medical authorization
- Insurance verification
- Benefit verification
- Regulatory compliance
- HIPAA compliance
- Electronic health records
- Healthcare coordination
- Customer relationship management
- Data entry accuracy
- Technical troubleshooting
- Problem solving
- Critical thinking
- Team collaboration
- Adaptability and flexibility
- Effective communication
- Health insurance
Certification
Certified Nursing Assistant
Timeline
Health Plan Specialist
Medica
11.2025 - Current
Prior Authorization Specialist
Anthem
09.2021 - 10.2025
Technical Support Representative
Charter Spectrum
09.2016 - 09.2021
Certified Nursing Assistant
Missouri Baptist Hospital
03.2013 - 09.2016
High School Diploma -
Pattonville High School
Some College (No Degree) - Nursing
Florissant Valley Community College