Sign in

Healthcare Specialists

New Orleans, LA
October 12, 2019

Contact this candidate







To acquire and maintain an advanced position in which I am confident of my skills and ability to communicate clearly, listen well, organize and implement paramount customer service.


Computer knowledge: Excel, Outlook, Mircosoft, Word

Phone systems: Avaya, CISCOs and insurance companies

Basic Office equipment: Fax machine, printers, Zebra labeling printers,and scanning machine, WOW (work on wheels)

Software knowledge: Care Radius, Xmedius, Medisoft, Epic, Peoples Place, Medco,

Medical knowledge : Medical Terminology, CPT codes, Diagnosis Code, HCPCS II Home Health process, DME process, IV Therapy process experience in Medicare / Medicaid Billing and the knowledge of the guidelines for Reimbursement.

Confident in working independently without supervision.


Baylor, Scott and White Hospital 09/2019

Medix Staffing Agency- Contact person: Jamal Mayfield 972-***-****

Patient Access Representative I

I obtain current and accurate demographics and Insurance information in order to register patients. Verify insurance benefits, negotiates and collects patient financial responsibilities. Contacts patients and insurance company representatives by the way of phone, or website. Obtain accurate insurance information for billing and claim purposes. Work patient’s que and review outstanding accounts for missing information. Make calls and counsel patients on financial arrangements for past due accounts.

HMS Retrieving Company 06/2019 to 8/2019

CTG Staffing Company: Michele Reilly @

Verification Specialist

Perform as subject matter expert in all aspects of verifications process. Understand verification platform. Grasp software and carrier access methods. Identify areas needing training and report to Supervisor. Review feedback from Quality Assurance team and counsel team members. Master day-to-day knowledge of the Verification’s department and follow best practices. Verify pharmacy coverage insurance policies (as requested) and maintain quality score of 95% accuracy or better.

TriWest Healthcare Alliance 2016 to 2019

Supervisor: Laquesha Simmoneaux-Wells 504-***-****

Care Authorization Specialist

Review and process Veteran care referral requests from the Department of Veterans Affairs (VA) Medical Centers and community health care professionals. Review and process medical documentation from community providers following Veteran care and treatment. Transmit this information to the referring VA Medical Center to complete the Veterans medical record and ensure ongoing care coordination while work in the community staff and community medical offices to address and resolve any incomplete information required for Veterans treatment and care. Protect the health care privacy of patients by strictly following HIPAA regulations. Follow processes of the VA program and perform all tasks in a courteous and professional manner. Understand and work with standard coding systems including standard medical taxonomy, International Classification for Diseases, Current Procedural Terminology, and Health Care Common Procedure Coding System. Work in a variety of systems to perform required tasks. Manage prioritized tasks in a time-sensitive environment.

Perform other tasks as assigned by leadership. Review and process SAR’s request and SAR follow-up in a timely manner.

Silverback Care Management 2015 to 2015

Aerotek Staffing

Non-Clinical Intake Specialist II

Perform high levels of data entry. High volume of inbound calls daily (100-150). Process 100-150 authorizations and referrals daily. Successful handle a high level of inbound and outbound phone calls. Be responsible for following non-clinical algorithms for initial preauthorization of services and intake documents for completeness. Ensure the overall data integrity of documents received and into computer system. Consistently meet performance standards of speed and accuracy. Secure patient demographics, verify benefits, and request and enter clinical history. Follow up on Out of Network and In Network benefits and redirect to proper PPL. Comply with established Silverback procedures and personnel policies. Reviewing paper and electronic medical records. Review and research denial payments, and EOC.

Peoples Health Network 2009 to 2014

Contact Person: Human Resources 504-***-****

Authorization Coordinator

Responsible for initial contact for hospital admit and discharges. Admit patient information into the system Provides data input support to Medical Management activities on the authorization process through the appropriate and accurate data entry of requested services. Also serves as the first contact for provider offices phoning to obtain information on prior authorization (s) and Medical Necessity Form. Responsible for initial inquiry into the database to determine eligibility, duplication of services, and previous authorizations for members. Responsible for reviewing the completeness of the request, initial data entry of authorization request information and builds the administrative component of the authorization. Forwards all pended authorizations requiring clinical review to the licensed nurse for clinical interpretation and determination of appropriate criteria to review. Assists in obtaining medical/clinical information from the provider offices as directed by the respective team member, Supervisor or Manager as it pertains to the referral process. Responsible for obtaining all signed orders for Home Health set up, DME, IV Therapy Physical Therapy, Rehab Therapy, LTAC, Skilled Nursing admits.

Pan America Life Insurance 2008 to 2009

Office Team Staffing 504-***-****

Customer Service Representatives

Check to ensure that appropriate changes were made to resolve customers' problems. Refer unresolved customer grievances to designated departments for further investigation or work and review insurance policy terms to determine whether a loss is covered by insurance. Complete contract forms prepare change of address records, or issue service discontinuance orders, using computers. Review insurance policy terms to determine whether a loss is covered by insurance. Provide customer service, such as limited instructions on proceeding with claims. Organize with detailed office records, using computers to enter access, search or retrieve data. Transmit claims for payment or further investigation. Verify benefits and eligibility. Contact insured or other involved persons to obtain missing information.

Visiting Physician’s Network 2005 to 2008

Supervisor: Dr. Tony Bui

Office Management

Collect, record, and maintain patient information, such as medical history, reports, and examination results, while making sure they have knowledge of VPN policies and procedures and expectations. Conducting monthly in-service for staff and new hires. Maintain certain decision making while remaining calm under pressure. Make sure all paperwork for staff timesheet are imputed in a timely manner. Attend weekly meeting. Perform administrative support tasks, such as proofreading, transcribing handwritten information, while making sure that ICD-9 and CPT codes were correct on the superbill before submitting it to proper Insurance Company. Receive payment and record receipts for services. Schedule appointments and maintain and update appointment calendars. Plan administer and control budgets for contracts, equipment and supplies.

Plan meet and greets for new facilities. Greet visitors or callers and handle their inquiries according to their needs. Confirming orders for Home health, DME, X-rays, medications per doctor's request. Operate office equipment such as fax machines, copiers, and phone systems, and computers. Open, read, route, and distribute incoming mail or other materials and answer routine letters. Knowledge of Complete forms in accordance with company procedures. Prepare and scan patient's information into their charts. Schedule and confirm appointments for clients, customers, or supervisors. Conduct searches to find needed information, such as medication assistant programs.


Nunez Community College

Health Information Technology 2014 to 2016

Study: ICD-9, ICD-10, CPT, HCPCSII, Reimbursement, Office management, collections,

reviews, electronic medical records, electronic data input, and retrieving, medical terminology, transcribing, medical law ethics, billing Medicaid, Medicare, Tricare and 3rd party, appeals & grievances. GPA: 3.75

Status: Incomplete.

Everest Community College

Medical Insurance Billing and Coding 2005 to 2006

Study: ICD-9, CPT, HCPCSII, Reimbursement, Office management, collections, reviews, medical records, data input, and retrieving, medical terminology, transcribing, billing Medicaid, Medicare, Tricare and 3rd party, 1500 forms, UB400 forms

GPA: 3.46 /

Honors; Deans List

Status: Completed: February 2006 w/ Diploma

North Texas Christian Academy

General Education Development: GED 2004 to


Studies: Math, Reading, Science, Language, Social Studies

GPA: 4.0

Honor: Honor Roll

Status: Completed, March 2005 Diploma

Contact this candidate