Elicia Douglas
Sanford,FL
Summary
Claims Specialist offering extensive experience in medical terminology and customer support within insurance and pharmaceutical settings. Adept in gathering and recording time-sensitive information accurately and according to established protocols. Highly capable and self-motivated, quickly developing product and procedural knowledge.
Overview
8
8
years of professional experience
Work History
Medical Reimbursement Specialist
Copilot Service Group
Maitland, FL
07.2021 - Current
- Processed requests from physicians' offices for pre-authorization of tests or treatments.
- Provided assistance with claims processing when needed, including filing appeals as necessary.
- Maintained confidentiality of all patient information in accordance with HIPAA regulations.
- Reports any reimbursement trends/delays to supervisor.
- Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program.
- Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications.
- Completes and submits all necessary insurance forms in a timely manner as required by all third party payors for prior authorizations. Tracks and follow up on prior authorization request.
- Processes any necessary insurance/patient correspondence.
- Provides all necessary documentation required to expedite prior authorization request. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians.
Prior Authorization Specialist
CVS/caremark
Orlando, FL
11.2018 - 06.2023
- Assisted with developing policies and procedures related to prior authorizations.
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
- Provided guidance to providers regarding the prior authorization process.
- Performed quality assurance reviews on completed work products before submission to payers.
- Reviewed prior authorization requests for completeness and accuracy.
- Coordinated resolutions for issues and appealed denied authorizations.
- Analyzed claims data from multiple sources to identify areas of potential cost savings.
- Maintained files for referral and insurance information, entering referrals into system.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
Benefit Verification Specialist
AssistRx
Orlando, FL
07.2015 - 10.2018
- Ensure cases move through the process as required in compliance with company requirements and the organization's defined standards and procedures; in a manner that provides the best level of service and quality.
- Conduct benefit investigations for patients by making outbound phone call to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers.
- Verify patient specific benefits and document specifics including coverage, cost share and access/provider options.
- Identify any coverage restrictions and details on how to expedite patient access.
- Document and initiate prior authorization process and claims appeals.
- Report any reimbursement trends or delays in coverage to management.
- Act as a liaison for field representatives, health care providers and patients.
Education
Associate of Science -
Seminole State College of Florida
Sanford, FL06-2025
GED -
Seminole State College of Florida
Sanford, FLSkills
- Financial Documentation
- Customer Service
- Expense Tracking
- Job Billing
- Word Processing
- Billing and Coding
- Medical Terminology
Timeline
Medical Reimbursement Specialist
Copilot Service Group
07.2021 - Current
Prior Authorization Specialist
CVS/caremark
11.2018 - 06.2023
Benefit Verification Specialist
AssistRx
07.2015 - 10.2018
Associate of Science -
Seminole State College of Florida
GED -
Seminole State College of Florida
Similar Profiles
Aisha BlackwellAisha Blackwell
Substitute Teacher at Copilot Service GroupSubstitute Teacher at Copilot Service Group
Eva SalvatierraEva Salvatierra
Intern at Copilot PublishingIntern at Copilot Publishing
TATIANA ARROYOTATIANA ARROYO
Substitute Teacher at Copilot CareersSubstitute Teacher at Copilot Careers
Kayla HowellKayla Howell
Cashier at ChipotleCashier at Chipotle
Kiana AcostaKiana Acosta
Stocker at WalmartStocker at Walmart