Desiree Banks
Houma,Louisiana
Summary
Healthcare claims and benefits professional with 9 years of experience in claims processing, prior authorization, insurance verification, patient access, and benefits administration. Experienced in reviewing claims and benefits, researching discrepancies, resolving complex coverage issues, and supporting medical appeals. Skilled in applying insurance guidelines, investigating issues, and communicating accurate resolutions while maintaining HIPAA compliance and confidentiality.
Overview
9
9
years of professional experience
Work History
Prior Authorization Specialist
OCHSNER HEALTH SYSTEM
Houma, LA
05.2020 - Current
- Coordinated prior authorization processes for medical services and procedures, ensuring timely completion and compliance with insurance guidelines.
- Reviewed medical documentation, insurance requirements, and service details to ensure accurate authorization decisions.
- Maintained knowledge of insurance plan requirements and completed authorization documentation accurately and within required timeframes.
- Submitted retro authorizations for additional services rendered after the initial authorization by reviewing medical documentation, insurance requirements, and service details to support accurate processing.
- Monitored the status of authorization requests to ensure timely processing. and followed up on pending cases.
- Provided clear, professional support to patients and healthcare providers regarding authorization and coverage questions.
- Maintained HIPAA compliance and strict confidentiality when handling sensitive patient and insurance information.
- Entered and revised patient information in electronic health record systems, ensuring data accuracy. in electronic health record systems.
Senior Chat Representative
CIGNA
06.2023 - 08.2026
- Supported members across medical and dental lines through simultaneous chat interactions involving claims, benefits, eligibility, coverage, and account inquiries.
- Reviewed claims and benefit information to ensure accurate eligibility and coverage determinations, facilitating appropriate resolutions in accordance with plan guidelines.
- Investigated claim discrepancies and complex member issues, conducting thorough research on account and benefit details to provide accurate resolutions.
- Reviewed claim scenarios and benefit requirements, applying established policies and procedures to support accurate claims outcome.
- Resolved claim and coverage concerns through clear written communication, ensuring HIPAA compliance and maintaining confidentiality while delivering accurate member support.
- Managed multiple systems simultaneously while maintaining quality, productivity, and a strong member experience.
- Remote
Patient Account Representative
OCHSNER HEALTH SYSTEM
09.2017 - 05.2020
- Managed patient registration and account processes, ensuring accurate data entry and compliance with healthcare regulations.
- Verified insurance eligibility and benefits, helping streamline approvals and improve patient access to services.
- Supported accurate billing workflows by verifying eligibility, obtaining required authorizations, and entering claim and patient information accurately.
- Supported billing workflows by verifying insurance eligibility, obtaining authorizations, and accurately entering claim and patient information.
- Worked remotely to support healthcare operations and patient services.
Education
GED -
High School/GED
Skills
- Inbound & Outbound Calling
- Prior authorization
- Retro authorization
- Insurance verification
- Medical records review
- Benefits coordination
- Eligibility review
- HIPAA compliance
- Account resolution
- Attention to detail
- Written communication
- Problem solving
- Time management
- Customer service
- Authorizations
- Medical office procedures
Personal Information
Title: Healthcare Claims, Benefits & Prior Authorization Specialist
Timeline
Senior Chat Representative
CIGNA
06.2023 - 08.2026
Prior Authorization Specialist
OCHSNER HEALTH SYSTEM
05.2020 - Current
Patient Account Representative
OCHSNER HEALTH SYSTEM
09.2017 - 05.2020
GED -
High School/GED