La Donya Simmons
Summary
Throughout my working career, I have demonstrated the ability to be detail oriented, reliable, organized, self-directed, with the ability to work in a fast-paced environment. I take pride in working hard, learning new things, as well as enjoying challenges and demands. I can function well in dynamic and changing environments as well as interact effectively with all levels of individuals.
Overview
14
14
years of professional experience
Work History
Insurance Specialist
Medix Infusion Pharmacy
Addison, Tx
08.2023 - Current
- Calculate patients’ out of pocket expenses using their pharmacy and medical benefits for Infusion therapy at the infusion center or home
- Find patients copay, grants and reimbursement assistance to help with the cost of medications and other fees
- Calculate and set patients on a payment plan if they are not able to afford therapy
- Conduct prompt and thorough verification of insurance benefits for both major medical and pharmacy coverage for patients prescriptions through various online resources
- Start and complete prior authorizations and appeals processes for patients who have been denied coverage for needed medication.
Benefit Liaison
Paragon Healthcare
Dallas, Tx
11.2022 - 08.2023
- Calculated the out of pocket costs for patients’ infusion therapy and home health cost using their medical benefits
- Advise patients, sales representatives, and case managers of patients out of pocket expenses by telephone or email
- Advise patients if therapy will be in network or out of network and the cost difference depending on if their coinsurance and what has been met towards each benefit.
Benefits Insurance Specialist
Amerisourcebergen
Carrollton, TX
01.2017 - 08.2022
- Conducted a prompt and thorough verification of insurance benefits for both major medical and pharmacy coverage for patients prescriptions through various resources
- Reviewed, prepared, and managed, all clinical documents from prescriber to submit prior authorization request or write appeals in the case of denials on behalf of the prescriber and patient
- Acted as liaison between patient, payor and prescriber to keep them informed of timely updates and investigation status
- Managed requests for additional information as needed
- Affirmed and determined coverage of claims and calculates patients financial costs
- Coordinated payment assistance with patients who are experiencing financial hardships with manufacturer programs
- Trained new employees on processes and computer systems
- Assisted with department projects and provided feedback on process improvements which had been implemented to increase productivity and better workflow processes
- Manage department emails and assign work to team members
- Prepared and modified reports and correspondence using word processing software.
Insurance Specialist
Walgreens Specialty Pharmacy
Frisco, TX
04.2015 - 05.2016
- Utilized payer websites to obtain insurance coverage
- Verified patient insurance cost of medications and administration
- Facilitated and completed the prior authorization process, coordinated benefits, ran test claims, and advised patients of financial responsibility
- Maintained confidentiality of patient finances, records and health statuses
- Tracked pending authorizations to resolve discrepancies and avoid revenue loss
- Took on the role as night lead, monitoring and assigning new and refill orders to team members
- Ensured each person's work was completed, and worked properly through to completion to be packed and shipped to customers.
Document Control Coordinator
ADT Security Services
Irving, TX
12.2010 - 01.2014
- Ensured that sensitive and confidential information was accurately updated, scanned and processed in a secure database
- Updated and maintained account information such as client demographics, billing and payment history
- Engaged in planning, evaluating, and the organizing of process improvements and controls
- Prepared contracts for review for quality check before documents are scanned into the billing systems
- Kept track of case files and status of documents required for billing
- Complied with safety and security regulations as outlined in organizational procedures to minimize data breaches
- Researched discrepancies, prepared and provided a variance of analysis to identify the root cause.
Education
Bachelor of Arts - Psychology
Dallas Baptist University
Dallas, TX12.2024
Skills
- Interpersonal Skills
- Critical Thinking
- Heavy Workload Management Skills
- Meticulous Data Entry
- Customer Relation Management Skills
- Analytical Thinking
- Workflow Processes
- Customer Service
- Accurate attention to Detail
- Windows Proficient-Intermediate
- Account Management
- Claims Management
- Financial Planning
- Client Relations
- Client Retention
Timeline
Insurance Specialist
Medix Infusion Pharmacy
08.2023 - Current
Benefit Liaison
Paragon Healthcare
11.2022 - 08.2023
Benefits Insurance Specialist
Amerisourcebergen
01.2017 - 08.2022
Insurance Specialist
Walgreens Specialty Pharmacy
04.2015 - 05.2016
Document Control Coordinator
ADT Security Services
12.2010 - 01.2014
Bachelor of Arts - Psychology
Dallas Baptist University
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