Nakia Sutton
Orlando
Summary
Experienced professional with a strong background in quality assessment and review processes. Ensures accuracy and compliance. Collaborative and adaptable, excels at working with teams to drive high-impact results and adjust to shifting priorities. Valued for analytical skills, keen attention to detail, and excellent communication abilities. Known for reliability and resourcefulness, thrives in environments that require thorough evaluation and feedback.
Overview
9
9
years of professional experience
Work History
Contract Review Specialist
Cornerstone Advisors
02.2024 - 02.2025
- Triage files uploaded by vendors and clients
- Ensure files are not duplicated
- Entering NDA's into the system
- Red-Lining NDA's to ensure the language matches with the company requirements
- Entering GLB's received from the clients and vendors
- Responding to emails received from both vendors and clients
Fraud Investigator
CardWorks Servicing
10.2019 - 02.2024
- Investigate fraud
- Completes the necessary steps to properly conduct credit card claim investigations and respond to all claim related inquiries within regulatory or required timeframes
- Filing applicable chargebacks to help mitigate fraud losses for our clients
- Make and/or receive phone calls to cardholders and merchants when necessary for the claim investigations
- Monitoring all work queues to ensure that they are maintained accordingly
Reimbursement Specialist/Prior Authorization Coordinator
McKesson
10.2015 - 10.2018
- Proficient in obtaining patients medical benefits
- Experienced with benefit structure for Medicare B and D accounts
- Ability to initiate and process Prior Authorizations to completion
- Collaborate with healthcare providers to ensure Prior Authorizations are fulfilled in a timely manner
- Determine patient's financial responsibilities and enroll patients in Financial Assistance program if needed
- Knowledgeable in ICD10 and CPT codes
- Detailed and organized with notations and spreadsheets to ensure patients monthly infusions and financials are on schedule
- Proficient in handling high case and call volume
Education
High school diploma -
IRCC
Fort Pierce, FL03.2003
Skills
- Insurance Verification
- Excel Proficiency
- Data Analysis
- Customer Engagement
- Efficient Data Entry
- Proficient Phone Communication
- CPT Coding
- Strong Organizational Skills
- Team Leadership
- ICD-10
- Accurate Data Entry
- Understanding of HIPAA Regulations
- Customer Service Expertise
Personal Information
Work Permit: Authorized to work in the US for any employer
Timeline
Contract Review Specialist
Cornerstone Advisors
02.2024 - 02.2025
Fraud Investigator
CardWorks Servicing
10.2019 - 02.2024
Reimbursement Specialist/Prior Authorization Coordinator
McKesson
10.2015 - 10.2018
High school diploma -
IRCC
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