Summary
Overview
Work History
Education
Skills
About Me
Timeline
Generic

Felicia Cave

Houston,TX

Summary

Healthcare operations professional with more than five years of experience in hospital dispatch, managed care support, and medical administration. Skilled in interpreting healthcare benefits, processing coverage determinations, and resolving claims for Medicare and commercial plans. Experienced in handling very high call volumes, averaging over 10,000 per day, while maintaining accuracy, compliance, and quality service. Knowledgeable in medical billing and coding, including CPT, ICD-10, and DX codes, as well as prior authorization processing and provider remittance review. Recognized for staying calm under pressure, solving problems effectively, and working closely with physicians, providers, and internal teams to deliver accurate and timely results.

Overview

5
5
years of professional experience

Work History

Hospital Emergency Dispatch Operator

Baylor Scott & White
Temple, TX
11.2023 - 05.2025
  • Handled an average of 10,000+ calls per day, dispatching emergency medical teams and managing hospital-wide code communications (Code Blue, Trauma, Rapid Response).
  • Operated multi-line phone systems, overhead paging, and radio equipment to coordinate rapid medical response.
  • Documented all emergency activities in real time, ensuring HIPAA compliance and accurate reporting.
  • Monitored life safety systems, including fire panels and security alarms; initiated appropriate responses.
  • Delivered calm, clear, and effective communication under high-stress emergency situations.

Customer Service Specialist

Blue Cross Blue Shield of Alabama
Birmingham, Alabama
08.2021 - 11.2023
  • Resolved complex benefit and claim inquiries for Medicare and commercial members, aligning with current regulations and plan guidelines.
  • Interpreted coverage, processed escalations, and delivered consultative solutions across departments.
  • Attended regular policy training to stay compliant with Medicare updates.
  • Applied medical billing knowledge to recognize CPT, ICD-10, and diagnosis (DX) codes during claim entry and follow-up.
  • Processed coverage determinations and prior authorization requests by reviewing plan guidelines and medical necessity criteria.
  • Maintained accurate documentation and compliance with CMS guidelines and Medicare regulations.
  • Navigated multiple software platforms to research and explain claims and cost estimates clearly.
  • Participated in regular training to stay current with healthcare policy updates.

Medical Assistant

Taylo Internal Medicine Selma
Selma, Alabama
01.2020 - 11.2021
  • Leveraged expertise in CPT, ICD-10, and DX codes to identify billing discrepancies, correct claims, and streamline reimbursement processes.
  • Scheduled appointments, verified insurance eligibility, and updated patient records using EHR software.
  • Performed clinical support duties, including diagnostic testing (ECGs, X-rays), administering injections, and assisting with physical exams.
  • Initiated and followed up on prior authorization requests for diagnostic tests, procedures, and medications.
  • Reviewed provider remittance advices, and identified claim issues, denials, and resubmission opportunities.
  • Collaborated with physicians and billing teams to ensure accurate coding and documentation for patient visits.
  • Educated patients on treatment plans, procedures, and insurance-related questions.

Education

Medical Assistant -

Fortis College
Montgomery, AL
11-2020

Skills

  • Managed care and insurance benefit interpretation
  • Claims resolution and Medicare/commercial plan support
  • Coverage determinations and prior authorization processing
  • Medical billing and coding (CPT, ICD-10, DX codes)
  • Provider remittance review and denial management
  • High-volume call handling (10,000 calls daily)
  • Multi-line phone and call documentation systems
  • HIPAA compliance and confidential information management
  • Electronic Health Records (EHR) and data entry accuracy
  • Medical terminology and healthcare compliance regulations
  • Cross-functional collaboration with physicians and providers
  • Problem-solving and analytical decision-making in fast-paced environments
  • Strong verbal and written communication skills
  • Managed Care Representative II

About Me

  • I’m a healthcare professional with a background in hospital emergency communications, insurance customer care, and medical administration. I’ve worked in fast-paced environments where accuracy and clear communication are critical, handling everything from high-volume calls to complex benefit and claim questions. I enjoy problem-solving, supporting patients and providers, and making sure the right information gets to the right people quickly. My experience with medical billing, coding, coverage determinations, and prior authorizations has taught me how to navigate both clinical and insurance processes with confidence.

Work Type

Full TimeContract Work

Work Location

Remote

Important To Me

Career advancementWork from home optionWork-life balance

Timeline

Hospital Emergency Dispatch Operator

Baylor Scott & White
11.2023 - 05.2025

Customer Service Specialist

Blue Cross Blue Shield of Alabama
08.2021 - 11.2023

Medical Assistant

Taylo Internal Medicine Selma
01.2020 - 11.2021

Medical Assistant -

Fortis College