Donshay Douglas
Fort Worth
Summary
Results-driven insurance coordinator with expertise in healthcare analytics and project management. Adept at analyzing financial reports and collaborating with stakeholders to optimize revenue cycle processes and improve patient experience.
Overview
7
7
years of professional experience
4
4
years of post-secondary education
Work History
Insurance Coordinator
Fresenius Dialysis Center
Fort Worth
05.2023 - Current
- Coordinated with healthcare providers to verify patient insurance eligibility.
- Assisted patients in understanding their insurance benefits and coverage options.
- Managed insurance claims processing for patient services at a dialysis center.
- Processed payments for insurance premiums and maintained accurate records of all transactions.
- Efficiently managed collections and receivables, referrals process and billing to meet revenue goals.
- Analyzed weekly and monthly financial reports and reviewed accounts receivable reports and insurance contracts to facilitate revenue cycle management.
- Compiled data from various sources to prepare reports for management on a regular basis.
- Participated in meetings with senior management to discuss current projects and develop action plans for implementation.
Pharmacy Benefits Manager
Paydhealth LLC
Dallas
01.2020 - 04.2023
- COMPLIANCE
- Supported internal and external audits by complying with all federal and state laws applicable to the confidentiality of protected health information (PHI) and electronic protected health information (EPHI), and follow HIPAA guidelines regarding readily identifiable protected health information.
- Ensured compliance with security policies and federal regulations by leading training sessions for managers and new team members.
- OPERATIONS
- Receive and respond to provider, member, and pharmacy callsregarding the prior authorization and formulary process-Track and trend override to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns.
- Resolve complaints and grievances related to the pharmacy network in collaboration with stakeholders-Manage third party vendor relationships including negotiations and business reviews.Resolve coverage issues by coordinating with insurance carriers
Customer Service Representative
Prime Therapeutics LLC
Dallas
01.2019 - 12.2020
- High school Intern Role
- Assisted health plan members, providers and pharmacies by researching benefit plans and resolving inquiries.
- Resolved drug coverage and prior authorization issues while maintaining accurate documents
- Handled administrative tasks including organizing digital records and processing paperwork
- Conducted outbound calls for follow ups and case resolution.
- Utilized CRM systems, order management tools and communication platforms for efficient service delivery
- Trained new customer service reps on company policies procedures and best practices-Participated on Process Improvement task force responsible for reviewing process within department, updating SOP’s and recommending changes to management
Education
Bachelor of Science - Computer And Information Systems
University of North Texas
Denton, TX 08.2020 - 05.2024
All Saints Episcopal School
Fort Worth, TX 08.2016 - 05/2020
Skills
- Claims processing
- Insurance verification
- Revenue cycle management
- Compliance auditing
- Project Management
- Salesforce
- HIPAA
- Change Management
- Pharmaceutical SME
- Healthcare Analytics
- Process Implementation
- Claims processing
- Data Analysis & visualization in excel
- Operations Management
- SAP
Timeline
Insurance Coordinator
Fresenius Dialysis Center
05.2023 - Current
Bachelor of Science - Computer And Information Systems
University of North Texas
08.2020 - 05.2024
Pharmacy Benefits Manager
Paydhealth LLC
01.2020 - 04.2023
Customer Service Representative
Prime Therapeutics LLC
01.2019 - 12.2020
All Saints Episcopal School
08.2016 - 05/2020