Debra Pais
Watauga,TX
Overview
16
16
years of professional experience
Summary
Experienced Benefits Verification Specialist with strong healthcare regulations knowledge, policy interpretation, and benefits communication skills. Known for accuracy, time management, and resolving complex coverage issues to
Detail-oriented healthcare professional with experience verifying insurance eligibility, pharmacy benefits, and prior authorizations. Skilled in communicating with payers, providers, and patients to resolve discrepancies and reduce coverage delays. Focused on accurate documentation and smooth reimbursement processing.
Benefits professional with strong foundation in verifying and processing claims, ensuring compliance with industry standards. Known for reliability and adaptability, consistently meeting dynamic needs of the team. Brings expertise in data management and communication, driving successful outcomes through collaborative efforts.
Work History
Benefits Verification Specialist
CVS Specialty Pharmacy
Monroeville, PA
09.2021 - Current
- Verified patient insurance eligibility and pharmacy benefits for specialty medication requests.
- Interpreted plan requirements to determine prior authorization, copay, and coverage restrictions.
- Communicated with payers, providers, and patients to resolve benefit discrepancies and coverage delays.
- Documented verification results accurately in pharmacy systems and patient records.
- Reviewed coordination of benefits details to support timely prescription adjudication.
- Escalated complex coverage issues and missing information to appropriate internal teams.
- Adhered to HIPAA guidelines while handling sensitive member and reimbursement data.
- Enhanced claim processing efficiency by reviewing and verifying insurance benefits information.
- Maintained up-to-date knowledge on industry regulations, ensuring compliance throughout all benefit verification processes.
- Ensured timely reimbursements by proactively identifying potential issues that could delay claim processing and addressing them before submission.
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions.
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Assisted clients with resolving complex benefits issues, improving overall customer satisfaction.
Medical Office Assistant
Alliance Foot and Ankle
Grapevine, TX
01.2011 - 10.2018
- Coordinated patient scheduling, appointment reminders, and calendar updates for smooth daily office flow.
- Verified insurance benefits, obtained authorizations, and resolved coverage issues for patient visits.
- Maintained accurate electronic health records, demographic updates, and chart documentation.
- Managed multi-line phones, patient messages, and front-desk inquiries with timely, professional service.
- Prepared patient intake paperwork, consent forms, and visit documentation for provider review.
- Processed referrals, follow-up instructions, and external record requests to support continuity of care.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Updated patient information and insurance details for accurate electronic medical records.
- Used EMR to schedule appointments for doctor visits and procedures.
Education
Medical Assistant - Medical Administration
Tarrant County College
Fort Worth, TXSkills
- Healthcare regulations
- Policy interpretation
- Benefits communication
- Accuracy and precision
- Time management
- Reliability
- Communication skills
- Networking skills
Timeline
Benefits Verification Specialist
CVS Specialty Pharmacy
09.2021 - Current
Medical Office Assistant
Alliance Foot and Ankle
01.2011 - 10.2018
Medical Assistant - Medical Administration
Tarrant County College