Leshun Campbell
San Antonio,TX
Summary
Professional summary
Knowledgeable and dedicated Patient service professional with extensive experience in Healthcare service industry with team lead involvement. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain Patient satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
6
6
years of professional experience
Work History
Csv III Prior Authorization Specialist
3m Healthcare
San Antonio, TX
07.2024 - Current
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Reviewed claims submitted without valid pre-authorization codes and took corrective action when necessary.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
Patient Advocate
iRhythm Technologies Inc.
San Francisco, CA
04.2023 - Current
- Provided knowledgeable and compassionate service in response to patient questions and concerns.
- Documented patient activities, problems with device wear and patch function
- Cultivated positive relationships with patients to help facility meet satisfaction scores and patients obtain best possible care.
- Maintained high satisfaction score by consistently resolving first-call issues.
- Educated patient where applicable to alleviate need for future contact.
- Researched resolutions, contacted necessary departments and responded to customer by phone, mail or fax as follow-up.
Patient Access Specialist
Exact Sciences Laboratories
Madison, WI
10.2021 - 02.2023
- Applied HIPAA privacy and security regulations while handling patient information.
- Verified demographics and insurance information to register patients in computer system.
- Reviewed eligibility responses to assess patient benefit level and assist accounts with any available coverages that could be updated .
- Updated 80-100 accounts Daily with patients files by reviewing medical records in a safe and secure Epic system
- worked with All insurance coverages through portals for eligibility
- worked with Medicare part A/b secondary Coverages, and All Medicaid insurances
- Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances if unattainable added a self pay charge to account
- Submitted appeals using provider portals and medical records with United Healthcare
- worked with Icd-10 cm coding to determine guarantors correct screening
- navigated over 100 work queues and charge entry with different content error to resolve
- Interpreted medical terminology information to translate information into Epic system.
Referral Specialist
Anthem, Inc
Westchester, IL
11.2020 - 07.2021
- Assist in answering telephone inquires from all physicians and healthcare professionals in a timely manner'
- Receive and complete incoming fax requests submitted by licensing healthcare professionals
- Evaluate and record client demographics provided by assigned physician to report as deemed necessary to clients insurance
- Institute member accounts and relay the coverage associated with their specific insurance policy and non-covered treatment/therapies
- Review referral details and expectations with providers and patients and requested new referrals when necessary.
- Obtain Prior Authorizations for services such as diagnostic imaging and Major surgeries.
- Identify HCPCS codes, ICD10 codes and CPT codes for healthcare claims and billing purposes
- Update daily spreadsheets
- Run daily statistics and email them over to assigned team members each morning for previous daily KPI's
Health Care Specialist
Byram Healthcare
Downers Grove, IL
06.2019 - 11.2020
- Managed a heavy amount of inbound calls in a timely manner
- Processed faxed orders from physicians containing orders and written prescriptions for disposable medical equipment
- Evaluated customer demographics and information as needed to complete requested orders
- Set up new Byram customer accounts and described the coverage's associated with their specific insurance policy and non-covered treatments/therapies
- Handled phone orders with patients for refills on their monthly supplies
- Identified HCPCS codes, ICD10 codes and CPT codes for healthcare claims and billing purposes
- Submitted pre-authorization and overage requests to the appropriate team
- Identified customer needs, clarified information, researched every issue and provided a solution
- Recorded and processed patient orders using the Enterprise Resource System (ERP)
- Maintained customer records by updating account information Processed returns and exchanges
- • Recommended additional products that may be available to the customer
- In addition to being a wound care specialist, assisted with other therapies, but not limited to, urology, ostomy, nutrition, diabetes, and incontinence
Assistant Coordinator
AXA Assistance USA
Chicago, IL
10.2018 - 02.2019
- Performed preliminary physical tests to accurately record results in patient history summary.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
- initiated guaranteed of benefits letters to physicians for clients with active plans for medical cost occurred
- commenced insurance claims on patients behalf
- Efficiently performed insurance verification and pre-certification and pre-authorization functions.
- Partnered with healthcare and administrative staff to create patient-centered, inviting and supportive environment for patients and families.
Education
Associates of Healthcare Administration - Healthcare Administration
Pima Medical Institute
Tucson, AZ2025
High School Diploma -
Lincoln’s Challenge Military
12.2011
High School Diploma -
Schurz High School
Chicago, IL06.2010
Skills
- Multi-line phone proficiency
- Insurance precertification processes
- Analytical
- MS Office expertise
- Accurate documentation
- Detailed oriented
- medical terminology
- Hippa Law
- Caring and Empathetic
- Epic system
- Erp system
- ICD-10
- microsoft office
- insurance verification
- high volume calling
- Complaint resolution
- patient medical records
- Anatomy and physiology terms
- Critical thinking
- Authorization verification
- Insurance information collection
- Medical terminology expertise
- Insurance company knowledgeable
- Medical billing
- Insurance plan verification
- Medicaid knowledge
- Information security
- Work well independently
- Data entry
- Working Remotely
Timeline
Csv III Prior Authorization Specialist
3m Healthcare
07.2024 - Current
Patient Advocate
iRhythm Technologies Inc.
04.2023 - Current
Patient Access Specialist
Exact Sciences Laboratories
10.2021 - 02.2023
Referral Specialist
Anthem, Inc
11.2020 - 07.2021
Health Care Specialist
Byram Healthcare
06.2019 - 11.2020
Assistant Coordinator
AXA Assistance USA
10.2018 - 02.2019
Associates of Healthcare Administration - Healthcare Administration
Pima Medical Institute
High School Diploma -
Lincoln’s Challenge Military
High School Diploma -
Schurz High School
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