Service Representative Authorization Specialist

Shameka Hallman

***** ******* *** *******, *****

***************@*****.***

832-***-**** direct contact

Objective

Seeking to continue a successful career in Administration and Management Services with a stable company offering experience

Contact information 832-***-**** ***************@*****.*** Summary of Qualifications

Experience Customer Services Interacting

Handled the receptionist role for several firms using a multiline phone systems Professional clients solving customer complaints and processing collections Experience handling inbound and outbound call issues Able to complete work assignments under minimum supervision Employment

CVS-Contingent

Prior Authorization Specialist

Prior Authorization/Appeals Specialists responsible for the entire process of prior authorization for CVS pharmacy claims. Manage communication between the members/ patients,healthcare providers, and insurance companies to request for prior authorizations on medication. Duties include ensuring complete and updated patients claim documentation, performing daily approvals of pending claims auditing accounts for accurate submission of claims, and making sure patient appeals processed effectively. Prior Authorization/Appeals also review outstanding claims and handle reimbursement or billing issues to ensure updated claims.

ABM

Coordinator Wheelchair Services

2018-2022

Mostly providing customer service and for passengers that requires medical travel additional and special needs throughout airport special transportation services. Assited with coordinator duties,supervisory and leadership position and lead agent position when needed. Verification of benefits and Hospital additional services towards traveling medical needs.Assists and transports passengers requiring wheelchair assistance at the airport to/ from gate.communications with other team agents working designated area providing accurate and friendly services

Wellness Coordinator

Independent contractor within Benfits Department worked with several community based agencies and large scale programs educate the public and one on one settings with clients as peer advisor and peer mentorship about healthy behaviors teach how to adapt to develop healthier lifestyles daily nutrition routine fitness and stress management Create health wellness workshops, health screenings, womens conferences teen mentor groups and zoom Texas Children Hospital

2007-2012

Business Service Representative

Providing in Dual Role daily administrative and account services, handling telephone calls, processing expense reports, updating reports and working on budget preparation. Create and maintain files and effectively organize the office of the Business Office Manager and Director of Administration Department. Effectively manage and execute key administrative projects as needed. Build and develop strong, collaborative relationships with peers and colleagues. Member Services-Customer Services Calls Verify insurance benefits and select the correct billing code for day surgery and diagnostic accounts. Also registering patients for day surgeries and lab testing. Financial counseling any patient’s payments or arrangements. Obtaining/documenting pre-authorization on patients accounts. Contacting patient’s portions according to insurance and hospital contracted rate. Ivory Healthcare Agency, Inc. Stafford, TX

2005-2007

Provider Coordinator

Using multiple phone lines conducting customer service with Medicare HMO/PPO companies. Scheduling Intakes Appointments with Healthcare Caseworker for Ivory Healthcare patients daily. Manage a team of 10-15providers/ employees conducting Out-of-Office Supervisory Visits to Ivory Healthcare patients' homes. Assuring care according to State of Texas guidelines to patients while receiving standard care. Following-up on all patients/provider

(employees) documents. Manually updated charts/files using Windows XP and Excel spreadsheets daily.

Education

Houston Community College -Certified Medical Business Administration Houston Community College -Certified Nurse Assistant Houston Community College- Certified Wellness/Stress Management

Contact this candidate