Heather Shepherd
Belle Chasse,LA
Summary
Dynamic professional with extensive experience at BioPlus Specialty Pharmacy, excelling in prior authorization and claims processing. Proven ability to enhance patient education and resolve billing discrepancies, demonstrating strong attention to detail and effective communication. A dedicated team player committed to optimizing processes and ensuring compliance with regulations.
Overview
18
18
years of professional experience
Work History
PA Representative
BioPlus specialty Pharmacy
Harvey, La
10.2019 - Current
- Reviewed and processed prior authorization requests efficiently, ensuring compliance with established guidelines.
- Maintained accurate records of all interactions related to authorizations within electronic health systems.
- Collaborated with insurance teams to resolve discrepancies and optimize authorization processes.
- Educated patients on necessary documentation for prior authorizations, enhancing understanding.
- Monitored changes in policies, ensuring adherence to Medicare, Medicaid, and HIPAA regulations.
- Conducted quality assurance reviews on work products before payer submission.
- Analyzed claims data to identify potential cost savings opportunities.
- Coordinated with healthcare providers to gather essential patient information for authorizations.
Dental Insurance Coordinator
Kids Dental Zone
Harvey, La
10.2007 - 10.2019
- Processed dental insurance claims accurately to ensure timely reimbursement.
- Verified patient eligibility and benefits for multiple insurance plans.
- Coordinated and scheduled patient appointments, managing cancellations effectively.
- Maintained precise records of transactions for auditing purposes.
- Collaborated with Accounts Receivable team to enhance billing activities.
- Resolved billing discrepancies and issues promptly, ensuring customer satisfaction.
- Prepared monthly reports summarizing practice activity for senior management review.
- Managed payroll processing and maintained employee records in compliance with regulations.
Education
Medical/Clinical Certification - Medical Assisting And Billing
Eastern College of Health Vocations
Metairie, LA08-2004
High School Diploma -
Boothville- Venice High School
Boothville05-1994
Skills
- Prior authorization
- Claims processing
- Patient education
- Billing resolution
- Medical coding
- Customer relationship management
- Effective communication
- Attention to detail
- Dedicated team player
- Strong work ethic
- Multitasking and organization
- Database entry
Timeline
PA Representative
BioPlus specialty Pharmacy
10.2019 - Current
Dental Insurance Coordinator
Kids Dental Zone
10.2007 - 10.2019
Medical/Clinical Certification - Medical Assisting And Billing
Eastern College of Health Vocations
High School Diploma -
Boothville- Venice High School
Similar Profiles
Rachael N. HooverRachael N. Hoover
Regional Sales Director - Southeast at Bioplus Specialty Pharmacy/Formerly Kroger Specialty PharmacyRegional Sales Director - Southeast at Bioplus Specialty Pharmacy/Formerly Kroger Specialty Pharmacy
John AmayaJohn Amaya
Patient Care Coordinator at BioPlus Specialty PharmacyPatient Care Coordinator at BioPlus Specialty Pharmacy
ADRIENNE IVANOFFADRIENNE IVANOFF
Utilization Management Rep II at BioPlus Specialty Pharmacy - CarelonRxUtilization Management Rep II at BioPlus Specialty Pharmacy - CarelonRx
Samaantha RynerSamaantha Ryner
Credentialing Analyst - Payor Contracting at BioPlus Specialty Pharmacy ServicesCredentialing Analyst - Payor Contracting at BioPlus Specialty Pharmacy Services
Bryce ArbourghBryce Arbourgh
Electrical Superintendent at Triad Electric & ControlsElectrical Superintendent at Triad Electric & Controls