Dejah Hardwick
Raleigh,NC
Summary
Support day-to-day program operations with expertise in records management and resource coordination. Skillfully meet diverse needs and address issues to maintain efficiency and program outreach. Demonstrated success in building long-lasting relationships.
Overview
5
5
years of professional experience
Work History
Claims Specialist
Allcare Plus Pharmacy
11.2022 - 02.2023
- Process claims accurately to enhance customer satisfaction and retention.
- Maintained knowledge of benefits claims processing, claims principles, medical terminology and procedures, and HIPAA regulations.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Determine and understand the coverage provided under a member’s health plan.
- Provided outreach for additional information for appeals and grievances.
- Reviews and adjudicates claims in accordance with claim processing guidelines.
Reimbursement Specialist
TrialCard
12.2021 - 08.2022
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
- Used Salesforce to process benefit transactions.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Determined prior authorizations for medication and outpatient procedures.
Credentialing Analyst
AMN Healthcare
10.2020 - 11.2021
- Confirmed data and licensing information through investigations and notified violators of required changes to bring operations into compliance.
- Conducted primary source verifications such as background checks and board certifications.
- Collected detailed notes on investigations and other communication to adhere to legal requirements and enhance recordkeeping.
- Entered into record-keeping systems appropriate data needed to create new records or update existing ones.
Outreach Associate
Ciox Healthcare
01.2019 - 08.2020
- Processed medical records requests from outside providers according to facility, state and federal law.
- Obtained necessary signatures on information release forms to obtain medical and treatment records from other service providers.
- Identified new methods to optimize medical records management.
- Managed over 50 customer calls per day.
- Maintained patient records in compliance with security regulations.
- Determined needed and relevant interventions based on each client's cognitive abilities and current needs.
Benefits Specialist
Conduent
06.2018 - 01.2019
- 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.
- Observed strict procedures to maintain data and plan participant confidentiality.
- Answered questions about eligibility determinations and plan options.
- Processed enrollment paperwork and benefits forms.
- Maintained confidentiality of all employee information.
Education
Bachelor of Science - Healthcare Administration
Fayetteville State University
Fayetteville, NC05.2023
High School Diploma -
Millbrook High School
Raleigh, NC06.2016
Skills
- Report Preparation
- Maintaining Client Records
- Implementing Client Care Plans
- Electronic Medical Record Software
- Collaboration and Teamwork
- Client Assistance Referrals
Timeline
Claims Specialist
Allcare Plus Pharmacy
11.2022 - 02.2023
Reimbursement Specialist
TrialCard
12.2021 - 08.2022
Credentialing Analyst
AMN Healthcare
10.2020 - 11.2021
Outreach Associate
Ciox Healthcare
01.2019 - 08.2020
Benefits Specialist
Conduent
06.2018 - 01.2019
Bachelor of Science - Healthcare Administration
Fayetteville State University
High School Diploma -
Millbrook High School
Similar Profiles
Geralyn EveretteGeralyn Everette
Care Manager at AllCare Plus PharmacyCare Manager at AllCare Plus Pharmacy
Debria FallsDebria Falls
Care Manager at Allcare Plus PharmacyCare Manager at Allcare Plus Pharmacy
Necole StephenNecole Stephen
Pharmacy Coordinator/Analysis REMOTE at ALLCARE PLUS PHARMACYPharmacy Coordinator/Analysis REMOTE at ALLCARE PLUS PHARMACY