Quality Assurance Medical
Resume:
**** ******** ** 314-***-**** or
St. Louis, MO shakidreawilliams@yah
SHAKIDREA WILLIAMS
Objective To secure a position with an organization offering
the opportunity for personal and professional
growth in an atmosphere of team support.
Experience 2010- Present Washington University
St Louis, MO
Precertification Coordinator
Obtaining authorizations and referrals for various
doctors for schedule surgeries and radiology
procedures
Always performed daily work assignments in
accordance with HIPAA, EMTALA and JCAHO Federal
regulatory standards.
Managed quality assurance on patient accounts for
coverage & benefits, and medical authorizations
through government & private payor online web
portals, and automated phone lines for patient
accounts.
Verify that Eligibility and Benefits have been
performed before the patients procedure is
performed.
Provide clinical information to insurance companies
in order to get the authorizations approved via
phone or fax.
Communicate to the providers office, hospital and
patient the approval or denial of authorizations.
2007- 2010 Tenet Healthcare/Conifer Revenue
Cycle St. Ann, MO
Insurance Verifier Level II
Obtain eligibility and benefits for scheduled
inpatient and outpatient procedures for multiple
hospitals, via telephone, internet and fax.
Initiate referral and pre-authorizations for
inpatient and outpatient procedures, request
pre-determinations for plan specific procedures.
Document this information to ensure proper
financial clearance.
Communicate with patients and facility to obtain
any missing information needed to financially clear
patient accounts.
Prepare estimated pricing for scheduled procedures,
to ensure proper pre-registration and billing.
Manage problem accounts, obtaining correct
demographic information.
Managed quality assurance on patient accounts for
coverage & benefits, and medical authorizations
through government & private payor online web
portals, and automated phone lines for patient
accounts.
Assisted with assignment of correct CPT Codes to
patient accounts for various medical procedures
depending ICD 9 code.
Always performed daily work assignments in
accordance with HIPAA, EMTALA and JCAHO Federal
regulatory standards.
Mentored team members on current organizational
software programs such as PBAR, Carepricer & IMACS,
VIWEB, ACE, and various insurance payor website
navigations.
2005-2007 Great-West Healthcare St. Louis, MO
Patient Accounts, Billing/Claim follow up
Handled inbound calls from members and providers to
verify benefit and claim information.
Follow up on reimbursements, corrected claims, fee
schedules and send out overpayment requests to
providers.
Process medical and dental claims submitted via
mail, fax or electronically.
Initiate pre-authorization for inpatient or
outpatient procedure, obtaining clinical
information over the phone or by fax.
Verified Benefits according to CPT codes or ICD 9
codes in Ingenix.
Provide clinical information to obtain DME and
supplies.
Obtain clinical information to follow thru on
corrected claims and appeals.
2002-2005 United Healthcare Earth
City, MO
Intake Coordinator
Handling outbound and inbound calls from patients
and mental health providers in regards to
authorizations and demographic changes.
Explain and relay insurance benefits to members and
physician personnel.
Process claims for reimbursement and collect on
unpaid co-pays, prepare referral forms, billing
reports, LOMN's and privacy letters.
Follow up on customer satisfaction.
Education 1994-1995 Empire College
Santa Rosa, CA
2008-Present Lindenwood University
St Charles, MO
Associated Degree_ Legal Administration
Currently pursuing Bachelors for Business
Administration
Skills Windows, Microsoft Applications,
Excel, Lotus Notes, Internet
Applications and 10-key touch.
Contact this candidate