Aiesha Dukes
Columbia,SC
Summary
Efficient Authorization Specialist with comprehensive knowledge of medical insurance policies, coding and procedures. Demonstrated ability to liaise effectively between patients, healthcare providers, and insurance companies for smooth transactions. Strengths include strong problem-solving skills, thoroughness in documentation and a keen eye for identifying inconsistencies. Proven impact in previous roles includes streamlined authorization processes, improved patient satisfaction rates, and reduced claim denials.
Overview
8
8
years of professional experience
Work History
Authorization Specialist
American Homeshield
Memphis, TN
01.2024 - Current
- Maintained current knowledge of applicable regulations, laws, and standards.
- Monitored daily workflow queues within the department ensuring all tasks are completed accurately and timely.
- Created spreadsheets utilizing Microsoft Excel for tracking authorization status updates from payers.
- Processed prior authorization requests in accordance with departmental guidelines.
- Provided customer service to internal and external customers related to authorization requests.
- Ensured timely submission of accurate documentation to support payment of services rendered by providers.
- Researched patient eligibility, coverage information, and benefit levels.
- Tracked authorization statuses using electronic databases or manual filing systems.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Reviewed authorization requests for accuracy and completeness.
Medical Claims Processor
BlueCross BlueShield of SC
08.2021 - 01.2024
- Researched and processed claims in accordance with business regulations, internal standards, and processing guidelines
- Verified procedure and diagnosis codes to ensure accurate and timely coding.
- Responded to company emails related to daily responsibilities, Zoom meetings, and new contracts
- Resolved system edits, audits, and claim errors through research and use of approved references.
- Coordinated edits and deferrals with internal departments, ensuring seamless updates to patient identification, health insurance, and provider files.
- Verified accuracy of provider data entered into the system including tax ID numbers, NPI numbers, address changes .
- Updated system records with payment information received from insurance companies or patients directly.
Medical Assistant
Capital City Medicine
06.2019 - 07.2021
- Praised for efficient handling of administrative duties (e.g., answering phones, scheduling appointments, maintaining medical records, processing patients, billing, and bookkeeping) that allowed doctors and nursing staff to focus on the health concerns of their patients
- Ensured the cleanliness, sanitation and maintenance of all facilities, exam rooms and equipment
- Demonstrated proficiency in taking patient medical histories and vital signs, as well as in performing venipunctures, injections, and diagnostic procedures.
Store Manager
New Square
06.2017 - 06.2019
- Recruiting, interviewing, hiring, disciplining, and firing staff at the store
- Creating employee schedules, assigning schedules and responsibilities to employees, checking to see if these responsibilities and assignments are carried through in the store
- Training new employees and providing ongoing education for employees
- Evaluating staff based on performance-based metrics
- Setting criteria for staff, such as sales performance and customer approval or complaints
- Giving staff financial goals and sales targets to meet on a scheduled basis
- Managing the store, both retail and company, inventory, including loss prevention through theft and breakage
- Helping to create advertising campaigns for attracting new customers and retaining current customers and helping to create both in and outside store promotions for attracting customers.
Department Manager
Walmart
08.2016 - 06.2019
- Set strategic long and short-term departmental goals and evaluate outcomes
- Motivate and inspire staff while facilitating personal growth
- Ensure high levels of productivity are maintained
- Guarantee the highest levels of quality are met
- Communicate job expectations to staff
- Conduct training and seminars for continued skills improvement
- Foster a productive working environment
- Establish adherence to company and industry regulations.
Education
Certified Medical Assistant -
Remington College
Columbia, SCSkills
- Administrative Support
- Data Entry
- Office Management
- Accounting
- Customer Service
- Customer Billing
- Project Management
- Budget Planning
- CPR Certified
- Microsoft Office (Excel, Word)
- Recordkeeping and data input
- HIPAA Compliance
- Claims Management
- Applicant support and service
- Medicaid knowledge
- Microsoft Office
Leadership Experience
Successfully led a team to exceed sales goals while maintaining excellent customer satisfaction scores.
Personal Information
Title: Administrative assistant
References
Available upon request.
Timeline
Authorization Specialist
American Homeshield
01.2024 - Current
Medical Claims Processor
BlueCross BlueShield of SC
08.2021 - 01.2024
Medical Assistant
Capital City Medicine
06.2019 - 07.2021
Store Manager
New Square
06.2017 - 06.2019
Department Manager
Walmart
08.2016 - 06.2019
Certified Medical Assistant -
Remington College
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