Summary
Overview
Work History
Education
Skills
Timeline
Generic

Davika Charles-Felder

Houston,US

Summary

Reimbursement Specialist with over 15 years of experience in the healthcare and insurance sectors, adept at enhancing customer engagement and optimizing benefit verification processes. Proficient in utilizing tools such as Excel, MS Office, and Salesforce to streamline operations, reduce errors, and boost efficiency. Committed to fostering teamwork and resolving reimbursement challenges, contributing to improved patient satisfaction and operational success through innovative solutions.

Overview

6
6
years of professional experience

Work History

REIMBURSEMENT SPECIALIST

Caremetx
08.2022 - Current
  • Verify medical benefits, ensuring accurate prior authorizations and copay assistance.
  • Streamlined verification processes, enhancing efficiency and reducing errors.
  • Collaborate with healthcare providers to resolve reimbursement issues promptly.
  • Utilize analytical skills to assess and improve benefit verification accuracy.
  • Contribute to team efforts, achieving measurable improvements in patient satisfaction.
  • Remote

BENEFITS VERIFICATION SPECIALIST

Lash Group
11.2020 - 08.2022
  • Conduct patient-specific benefit verifications with both public and private payers.
  • Research the prior authorization process.
  • Research the correct billing and claims methodology based on the current coding options available.
  • Ensure that information is accurately obtained and documented in detail in the program database.
  • Work closely with the Site Coordinators to analyze and respond to payer trends across regions.
  • Ensuring that all insurance information needed for billing and collection processes are appropriately obtained and recorded in the computer system. Collaborated with cross-functional teams to optimize the prior authorization process, fostering a culture of shared knowledge and continuous improvement.
  • Remote

CARE MANAGER

Allcare Plus Pharmacy
08.2019 - 06.2020
  • Responsible for answering in-bound calls and assisting customers with pharmacy related services.
  • Obtain client information by answering telephone calls; interviewing clients; verifying information.
  • Contact insurance companies for benefit investigation and coverage eligibility.
  • Complete prior authorizations with attention to detail and accuracy, to then have the prepared prior authorization reviewed by a clinical pharmacist.
  • Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance programs.
  • Provide customers with courteous, friendly, fast and efficient service.
  • Update job knowledge by participating in educational opportunities and training activities.
  • Work efficiently both individually and within a team to accomplish required tasks.
  • Maintain and improve quality results by adhering to standards and guidelines and recommending improved procedures.
  • Demonstrate analytic and problem solving skills, and understand the impact of individual decisions on other parts of the organization and the environment.
  • Application of techniques that continually improve the quality of care provided, patient.
  • Demonstrate an understanding of how the various components of the health care system is organized and financed, and how they interact to deliver medical and health.
  • Understand the patient experience, demonstrate a commitment to patients’ rights and responsibilities, and ensure that the organization provides a safe environment for.
  • Relationship Management.

Education

High School Diploma -

South Florence High School
Florence, SC

Skills

  • Microsoft Word (Expert), Powerpoint (Expert), Excel (Expert), Internet navigation (Expert), AS400 (Experienced), Windows (Expert), MS Office (Expert), Data input (Expert), Salesforce (Experienced), Customer Engagement (Expert), Data Analysis (Expert), Problem Solving (Expert), Insurance Verification (Expert), Team Collaboration (Expert), Patient Advocacy (Expert)
  • Claims processing
  • HIPAA compliance
  • HCPCS coding
  • Appeals handling

Timeline

REIMBURSEMENT SPECIALIST

Caremetx
08.2022 - Current

BENEFITS VERIFICATION SPECIALIST

Lash Group
11.2020 - 08.2022

CARE MANAGER

Allcare Plus Pharmacy
08.2019 - 06.2020

High School Diploma -

South Florence High School

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