Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Delorian Smith

Louisville,Kentucky

Summary

Highly skilled in navigating complex prior authorization processes, bringing generosity, patience, and empathy to every interaction. Adept at building strong relationships with healthcare providers and insurance companies, ensuring efficient and accurate handling of authorization requests. Possesses persuasive communication skills and collaborative spirit, consistently achieving positive outcomes for patients and stakeholders. Known for dedication to helping others, always striving to streamline processes and improve patient access to necessary treatments.

Overview

6
6
years of professional experience

Work History

Prior Authorization Specialist

LHC
01.2024 - 07.2024
  • Managed incoming calls from providers regarding status updates of pending authorizations
  • Reviewed medical records thoroughly before submitting them for preauthorization review process
  • Maintained up-to-date knowledge of insurance policies and procedures related to prior authorization requirements

Billing Specialist

Synchrony Pharmacy
06.2023 - 12.2023
  • Resolved customer inquiries regarding billing, charges, and payments
  • Maintained accurate and complete billing system and process
  • Handled escalated cases from customers regarding billing disputes professionally
  • Provided timely follow up on past due accounts using phone calls, emails or letters

Case Manager

Mckesson.com
10.2018 - 04.2023
  • Helping patient get prior authorization approval for certain medication
  • Contacting patients insurance and pharmacy benet manager
  • Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
  • Enhanced communication between clients and providers through consistent follow-ups and progress updates.
  • Achieved positive client outcomes by developing and implementing comprehensive case management plans.
  • Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.

Environmental Service

Norton Women and Children
06.2018 - 10.2018
  • To ensure the cleanliness and sanitation of the facility

Education

HIGH SCHOOL OR EQUIVALENT -

Bluegrass Challenge Academy
05.2009

Skills

  • Customer Service
  • HIPAA Compliance Knowledge
  • Medicare and Medicaid knowledge
  • Effective communication skills
  • Pharmacy benefit management
  • Workflow Management
  • Benefit Coverage
  • Authorizations
  • Claims processing experience

References

  • Takesha Harris, CNA Friend, (502) 415-4693, keshaharris@icloud.com
  • Larissa Ndiaye, Career Coach Cousin, (502) 693-4468, Larissa.Ndiaye@goodwillky.org

Timeline

Prior Authorization Specialist

LHC
01.2024 - 07.2024

Billing Specialist

Synchrony Pharmacy
06.2023 - 12.2023

Case Manager

Mckesson.com
10.2018 - 04.2023

Environmental Service

Norton Women and Children
06.2018 - 10.2018

HIGH SCHOOL OR EQUIVALENT -

Bluegrass Challenge Academy

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Delorian Smith