Patient Services & Prior Authorization Specialist

Sharon Terrell-Johnson

Palmdale, CA *****

************@***.*** 661-***-****

Summary:

More than 6 years of experience with Patient Services Representative role including collaborating with other departments, such as claims, billing, and customer service, call center to resolve issues and streamline processes.

Familiarity with Epic's prior authorization functionalities is essential for efficient workflow management.

Complete and submit prior authorization requests to insurance companies based on the specific requirements outlined by each provider.

Updated on the latest regulations, guidelines, and policies related to insurance benefits and prior authorizations includes compliance with HIPAA regulations and any other applicable laws or regulations governing patient privacy and medical records.

Additionally, has experience with Authorization, medical billing and appeal claims, HMO, PPO, Medicare, and Medicaid.

Technically proficient in MS Office including Excel, Word, Outlook, SharePoint, EPIC, Meditech, and more.

Available for an interview any day between 12:15 pm and 1:00 pm, with a 12-hour notice, and can start immediately upon receiving an offer.

Education:

Antelope Valley Adult School- Lancaster, CA- G.E.D

National Computer Training School Palmdale, CA -Diploma

SKILLS:

Microsoft Office (9 years), Excel (6 years), Word Processing (6 years), Power Point (6 years),

Medical Terminology

EMR Systems, Epic

Heavy calling (100+/day), call center

Claims Processing, Appeals, Insurance Verification, ICD-10, Time Management.

Professional Experience:

Episource /Robert Half March 2025 to June 2025

Requesting medical records from physician offices

Rally Health /Robert Half Oct 2024 to Jan 2025

Member service representatives

Verify eligibility and demographic

Explain employee benefits and requirements.

Cedars- CA

Patient Services Representative (contract/remote) Jan 2024 to Apr 2024

Utilize the Epic electronic health records (EHR) system to access and manage member information effectively.

Monitor and maintain data accuracy within Epic, regularly reviewing records and addressing any discrepancies or issues.

Processed referrals from healthcare providers, ensuring accuracy and completeness of documentation.

Verified patients' insurance coverage and obtained necessary authorizations for specialist visits or procedures.

Communicated with patients to schedule appointments with specialists and provide necessary information regarding referrals.

Liaised with healthcare providers and specialists to coordinate patient referrals and ensure timely access to care.

Followed up on pending referrals to ensure completion and proper documentation.

Documented referral activities and outcomes in the electronic medical records system.

Provided assistance and support to patients and healthcare providers regarding referral inquiries and issues.

Employment Gap: Contract ended, seeking new opportunities.

Sutter Health - CA

Pre-Registration Representative (contract/remote) Apr 2022 to May 2023

Registered patients for upcoming appointments, ensuring all necessary information was accurately recorded and entered into the EMR system.

Verified patients' insurance coverage and obtained pre-authorizations as required for scheduled procedures or services.

Collected demographic and insurance information from patients, updating records as necessary to ensure accuracy.

Assisted with completing registration forms and answering any questions they had about the registration process.

Communicated with healthcare providers and other relevant staff to coordinate patient appointments and ensure smooth workflow.

Resolved any registration-related issues or discrepancies by working closely with patients and internal providers.

Maintained patient confidentiality and adhered to all HIPAA regulations throughout the registration process.

Employment Gap: Contract ended, seeking new opportunities.

California (BCSH)- CA

California COVID Rent Relief Representative (contract/remote) Sep 2021 to Jan 2022

Contacted tenants to assist with rental assistance, averaging 30+ calls and emails per day.

Reached out to landlords to obtain required documents for rental assistance applications.

Processed applications and collected necessary documents, then forwarded them for review by the state.

Maintained regular communication with tenants and landlords to keep them updated on the status of payments and applications.

Team Health- CA

Reimbursement Specialist (remote) Jul 2019 to Sep 2021

Processed insurance claims for reimbursement, ensuring accuracy and compliance with company policies and procedures.

Reviewed and verified reimbursement requests to confirm eligibility and accuracy of billing information.

Communicated with insurance providers regarding reimbursement status, inquiries, and any necessary follow-up actions.

Resolved reimbursement discrepancies and issues by conducting thorough research and liaising with relevant parties.

Maintained accurate records of reimbursement transactions, including payments received and outstanding balances.

Collaborated with team members to streamline reimbursement processes and improve efficiency.

Updated reimbursement policies and procedures as needed to reflect changes in regulations or company guidelines.

Provided support and assistance to clients and internal stakeholders regarding reimbursement inquiries and concerns.

Participated in training sessions and workshops to stay updated on industry trends and best practices related to reimbursement processes.

Conducted data entry tasks to enter reimbursement information into the system and ensure proper documentation of all transactions.

Employment Gap: Contract ended, seeking new opportunities.

Southern California Edison – Rosemead, CA

Administrative Assistant (contract) Jul 2018 to Nov 2018

Created detailed spreadsheets for analysts and assistant customers to facilitate in-office visits, ensuring all necessary information was accurately recorded.

Scheduled appointments for clients and followed up with confirmation calls to ensure attendance and minimize no-shows.

Handled incoming phone calls, addressing inquiries, and assisting callers professionally and courteously.

Managed office supplies inventory, placing orders as needed to ensure adequate stock levels for smooth office operations.

Updated calendars with appointments, meetings, and other important events to keep schedules organized and up to date.

Completed Temporary Power Form as required, ensuring all relevant information was accurately documented and processed promptly.

Contact this candidate