Carlita Dawkins
Wayne,MI
Summary
Seasoned Specialist offering 14+ years of comprehensive experience interpreting and implementing quality assurance standards and investigating customer complaints and non-conformance issues. Practiced and knowledgeable professional possessing excellent problem solving and analytical skills paired with strong knowledge of QA terms, tools and methodologies. Committed to improving overall business processes. Works great alone or with others.
Overview
16
16
years of professional experience
Work History
Prior Authorization Verification Specialist
Walgreens Alliance RX
Canton, MI
01.2018 - 09.2023
- Observed strict procedures to protect sensitive patient information, including medical records and payment data
- Verified all patient demographic information when registering for services
- Received, recorded and addressed incoming and outgoing communication via telephone and email
- Documented patient medical information, case histories and insurance details to facilitate smooth appointments and payment processing
- Managed financial documentations such as expense reports and invoices
- Input patient data regarding claims and prior authorizations into the system accurately
- Reviewed insurance coverage for patients to determine which party was liable for payment
- Reached out to insurance carriers to obtain prior authorization for testing and procedures
- Researched denied claims and contacted insurance companies to resolve billing issues
- Worked with Physician office to obtain proper CPT and ICD 10 codes for billing
- Identified needs of customers promptly and efficiently.
Insurance Verification Specialist
Walgreens Prime RX
Canton, MI
11.2010 - 12.2017
- Resolved problems with areas such as communication and billing that could negatively impact services
- Established rapport and relationships with patients and external partners to cross-train and support medical staff
- Educated patients by explaining preparation instructions for upcoming procedures and tests
- Liaised with pharmaceutical representative to schedule presentation appointments with physician
- Interacted kindly with insurance providers via phone, email and written correspondence to obtain the necessary documents to complete registration.
Patient Care Coordinator
Aerotek
Southfield, MI
11.2009 - 11.2010
- Answered phone calls and provided new clients with the required paperwork to initiate service
- Communicated directly with individuals and families to provide information about eligibility requirements, application details, payment methods and the applicants' legal rights during the intake assessment.
Durable Medical Equipment Biller
Phoenix Medical Supply Inc
Southfield, MI
09.2007 - 11.2009
- Filed and updated patient information and medical records
- Used CPT and ICD-9 to input information into computerized patient record system
- Reviewed patient records, identified the medical codes and created invoices for billing purposes
- Collected payments and applied to patient accounts
- Orchestrated day-to-day operations of the billing department, including medical coding, payment posting, accounts receivables and collections
- Translated and interpreted medical billing codes with strong accuracy to ensure swift payment from insurance agencies
- Prepared billing statements for patients and ensured correct diagnostic coding
- Verified proper ICD-9 coding on claims.
Education
Certificate of Completion - Medical Billing
Kaplan University
01.2007
Diploma -
Redford High School
01.1995
Skills
- Data Entry
- Remote
- Effective communication skills
- Healthcare billing
- Active listening skills
- Pharmacy insurance verification
- Insurance prior authorization
- Customer service
- Strong interpersonal skills
- Medical terminology knowledge
- Inbound/Outbound call center
- Patient Access Specialist
Systems
- Script Med
- VMware
- Teams
- Outlook
Timeline
Prior Authorization Verification Specialist
Walgreens Alliance RX
01.2018 - 09.2023
Insurance Verification Specialist
Walgreens Prime RX
11.2010 - 12.2017
Patient Care Coordinator
Aerotek
11.2009 - 11.2010
Durable Medical Equipment Biller
Phoenix Medical Supply Inc
09.2007 - 11.2009
Certificate of Completion - Medical Billing
Kaplan University
Diploma -
Redford High School
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