Customer Service Prior Authorization
Resume:
Shaista Ali
Prior Authorization Specialist
Arlington, TX
817-***-**** **********@*********.***
https://www.linkedin.com/in/shaista-s-ali
Detail-oriented Medical Assistant and Prior Authorization Specialist with 20+ years of customer service, administrative, and pharmaceutical billing experience. Considered a hard-working team player with exemplary multitasking skills. Seeking a new position where dedication and time management skills will be appreciated. SKILLS
Insurance and Billing Accuracy: Preauthorization obtainment, insurance verification, medical ICD-10 and CPT billing, HIPAA
Pharmaceutical Processing: Prescription processing, medication filling Customer Service: Time management, issue resolution Office Management: Case management, records maintenance, medical scheduling, clerical experience, medical terminology, vital signs, infection control training Tools: EMR Systems (Athena, Epic, Eaglesoft, Practice Fusion, etc.), Microsoft Word EXPERIENCE
DeSoto Healthcare Clinic, Irving, TX — Office Manager NOVEMBER 2022 - MARCH 2023
• HIPAA Compliance and Patient Information Security: Enhanced patient data integrity and security by revising HIPAA compliance protocols and consent forms, and by managing electronic health records with Practice Fusion EMR. Achieved meticulous organization and protection of patient information, including sensitive data such as EKG reports and comprehensive medical histories, while handling about 15-20 patient charts per day.
• Operational Efficiency and Patient Care: Boosted clinic operational efficiency and patient care quality by reengineering layout and documentation systems, which streamlined patient interactions and enhanced care delivery. Conducted monthly patient visits to monitor health statuses, managed annual wellness documentation, and prepared essential medical resources, demonstrating a proactive and patient-centered approach.
• Financial and Administrative Management: Ensured financial accuracy and compliance in patient billing through regular updates to insurance information and billing records, supporting efficient insurance claim processing and reducing discrepancies in patient accounts.
Cigna Healthcare, Remote — Claims Representative
MARCH 2022 - NOVEMBER 2022
• Claims Processing and Customer Support: Reviewed and verified insurance claims and patient eligibility for specialty medications, efficiently handling about 10 patient charts per day. Provided professional customer service by addressing queries and maintaining a warm attitude.
• Communication and Record Management: Managed high volumes of inbound calls, assisting members with insurance and demographic inquiries. Diligently recorded customer complaints, ensuring accurate documentation and follow-up. AMN Healthcare, Coppell, TX — Temporary Credentialing Specialist AUGUST 2021 - NOVEMBER 2021
• Credentialing and Verification: Performed accurate credentialing and verification of healthcare provider licensures, managing 5-10 cases daily to ensure compliance with regulatory standards.
• Case Management Efficiency: Maintained high efficiency in processing provider cases, ensuring timely and accurate verification to support healthcare operations.
Cardinal Health, Lewisville, TX — Case Manager
AUGUST 2019 - OCTOBER 2020
• Benefit Investigations and Prior Authorizations: Conducted thorough benefit investigations and managed prior authorizations for specialty medications, efficiently processing 15-20 patients per day while ensuring insurance coverage accuracy.
• Documentation and Compliance: Verified documentation receipt from doctors' offices and maintained compliance with HIPAA regulations, ensuring all forms were valid and up-to-date for scheduled patient appointments. DFW Wellness Pharmacy, Arlington, TX — Prior Authorization Specialist JULY 2016 - JUNE 2019
• Prior Authorization Coordination: Coordinated with insurance carriers and doctors' offices to secure prior authorizations for dermatological medications, effectively managing the needs of about 20 patients daily.
• Pharmacy Operations and Customer Service: Handled incoming calls, processed medication refills, and prepared prescriptions for dispensing by pharmacists. Also managed the packaging of medications for mailing, ensuring timely delivery to patients.
AccuExpress Service Providers, Arlington, TX — Credentialing Specialist JANUARY 2011 - DECEMBER 2011
• Application Evaluation and Profile Management: Assessed applications for accuracy and completeness, obtained National Provider Identifier (NPI) numbers, and updated provider profiles to ensure current information across systems.
• Provider Enrollment and Verification: Enrolled providers in Medicaid, Medicare, and private insurance plans, enhancing provider network capabilities. Conducted thorough primary source verifications, including background checks and board certifications, to maintain high standards of provider credentials. Apex Clinic of Texas, Carrollton, TX — Dental Office Manager MARCH 2008 - SEPTEMBER 2008
• Administrative and Patient Scheduling: Managed front-office tasks including answering calls, scheduling appointments, filing insurance information, and collecting co-payments for about 15 patients daily.
• Clinical Support and Dental Assistance: Provided clinical support by sanitizing instruments, setting up equipment for dental procedures, performing digital X-rays, and assisting dentists with various treatment protocols. EDUCATION
Mansfield Business School, Grand Prairie, TX — Medical Assistant MAY 1993
LANGUAGES
English, Urdu, Hindi
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