Summary
Overview
Work History
Education
Skills
Timeline
Generic

Danesha Fielder

Hammond

Summary

Driven professional with several years of experience facilitating referrals and obtaining authorizations and pre-certifications. Seasoned industry veteran at managing referral verification prior to patient appointments. Devoted to continually enforced practice procedures, requirements and regulations.

Overview

9
9
years of professional experience

Work History

Referral Specialist

UChicago Medicine
01.2025 - Current
  • Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.
  • Responsible for obtaining daily work list assigned to the employee to begin financial clearance process prior to the date of service for elective scheduled services and within payer guidelines for the notification of admission. Obtaining the authorization for the services rendered to ensure proper reimbursement and denial mitigation.
  • Secure all required clinical documentation needed to obtain the authorization
  • Maintain that all encounters needing verification is completed within 48 hours
  • Notify the patient as well as the ordering provider if an authorization has been delayed and work with the department to reschedule the services until the authorization of financial clearance has been obtained.
  • Handling phone calls from insurance companies, doctor offices and internal departments
  • Staying abreast of all insurance verification rules and regulations
  • Stays informed of state and federal regulations in relation to hospital reimbursement, and maintains communication with personnel in HIM departments and the business office to ensure accurate reimbursement
  • Documents the hospital operating system with all pertinent information to support the claim if applicable. This includes the reference number of the person you spoke with at the insurance company, the name, pending authorization, clinical information for clinical documentation, etc.
  • Requires the ability to sufficiently understanding insurance protocols for referrals, co-payments, deductibles, allowances, etc., and analyzes information received to determine patients’ out-of-pocket liabilities
  • Communicates the estimated out of pocket liability for the visit.
  • Handle a variety of task with speed, and attention to detail and accuracy.
  • Called insurance companies to get precertification and other benefits information on behalf of patients.
  • Verified insurance benefits and eligibility for procedures before referring clients.

Referral Specialist

TCA Health
12.2023 - 01.2025
  • Coordinated with provider offices to ensure timely completion of referrals prior to scheduled appointments.
  • Monitored changes in payer policies related to referral processing and communicated those changes internally.
  • Scheduled and confirmed patient appointments and consultations.
  • Routed laboratory or diagnostic results to appropriate staff.
  • Adhered to HIPAA requirements to safeguard patient confidentiality.
  • Resolved issues arising during the referral process, including insurance denials and appointment scheduling conflicts.
  • Managed and obtained insurance authorizations for patient referrals from physicians.
  • Obtained PA for services such as diagnostic imaging.
  • Researched and responded to inquiries from providers regarding pending or denied referrals in a timely manner.
  • Created reports summarizing referral activity on a weekly basis for management review.
  • Communicated regularly with referring physicians, nurses, case managers, social workers, and other healthcare professionals regarding referral processes and requirements.

Prior Authorization Specialist

BroadPath Healthcare
07.2022 - 10.2023
  • Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
  • Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Analyzed medical records and other documents to determine approval of requests for authorization.
  • Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
  • Responded to inquiries from healthcare providers regarding prior authorization requests.
  • Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
  • Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.

Call Center Customer Service Representative

Chicago Lighthouse
01.2018 - 04.2020
  • Handles 50+ customer interactions per day, giving detailed personalized, friendly and polite service to ensure customer retention and satisfaction.
  • Memorized all company products and services to be able to answer customer questions quickly and efficiently.
  • Collect source data such as customer names, addresses, phone numbers, credit card information and entering it into the customer service software.

Lead Sales Associate

Levy Restaurants
08.2016 - 04.2019
  • Monitored sales floor and merchandise displays for presentable condition, taking corrective action such as restocking or reorganizing products.
  • Logged reports, expenses, receipts and sales documents into digital database.
  • Opened and closed store independently and prepared nightly bank drop for manager.
  • Offered each customer top-notch, personal service to boost sales and customer satisfaction.

Education

Bachelor of Science - General Studies

Chicago State University
Chicago, IL
06-2028

High School Diploma -

Corliss High School
Chicago,IL
06-2011

Skills

  • Medical terminology
  • Pre-authorizations
  • Insurance authorizations
  • Customer service
  • Analytical and problem-solving ability
  • Excellent verbal and written communication
  • Microsoft Office

Timeline

Referral Specialist

UChicago Medicine
01.2025 - Current

Referral Specialist

TCA Health
12.2023 - 01.2025

Prior Authorization Specialist

BroadPath Healthcare
07.2022 - 10.2023

Call Center Customer Service Representative

Chicago Lighthouse
01.2018 - 04.2020

Lead Sales Associate

Levy Restaurants
08.2016 - 04.2019

Bachelor of Science - General Studies

Chicago State University

High School Diploma -

Corliss High School

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