Paulisha Davis
Houston,TX
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
8
8
years of professional experience
Work History
Insurance Verification Specialist
McKesson
01.2023 - 01.2024
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Provided timely follow up with payers regarding payment status of claims.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
Medical Authorization Specialist
Accredo Specialty Pharmacy
01.2021 - 01.2023
- Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet company set standards.
- Assists with the completion of medical necessity documentation to expedite approvals and ensures that appropriate follow up is performed.
- Coordinated communication between providers, patients, payers, and other departments as needed.
- Document insurance company interactions and all prior authorization information in system.
- Reviews insurance denials and submit appeals as permitted by payor.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Tracked authorization statuses using electronic databases or manual filing systems.
- Ensured timely submission of accurate documentation to support payment of services rendered by providers.
Patient Access Representative
Texas Vista Medical Center
01.2018 - 01.2021
- Verified insurance coverage for services provided by the facility.
- Collected co-pays and other payments from patients at time of service.
- Assisted with scheduling outpatient appointments.
- Responded to patient inquiries regarding billing or financial matters.
- Ensured accuracy of all data entered into computer system.
- Created new patient accounts in EMR system as needed.
- Performed pre-registration functions such as verifying demographic information, obtaining authorizations, and collecting deposits and co-payments.
- Facilitated communication between patients, staff members, and third party payers.
- Followed up on unpaid claims in a timely manner.
- Managed incoming faxes related to patient registration processes.
Patient Financial Services Representative
Conifer Health
01.2016 - 01.2018
- Answered incoming calls from patients regarding billing inquiries and resolved customer service issues.
- Assisted in the maintenance of patient accounts to ensure accuracy of information including demographic, insurance and financial data.
- Conducted follow-up on outstanding insurance claims and worked with other departments to resolve payment issues.
- Researched and responded to customer inquiries via phone, email, or mail regarding billing statements, services rendered.
- Verified eligibility for patients prior to appointment scheduling.
- Contacted third party payers regarding unpaid claims or denied claims for further investigation and resolution.
- Contacted insurance companies to check status of claim payments.
Education
Lincoln Academy High School
Houston, TX05-2011
Skills
- Communication and Interpersonal Skills
- Medical Terminology
- Attention to Detail
- Customer Service
- Insurance Coverage Verification
- Electronic authorization processing
- Eligibility Determination
- Electronic Medical Records
- Data Entry and Review
- HIPAA Compliance
- Claims Management
- Microsoft Office
Timeline
Insurance Verification Specialist
McKesson
01.2023 - 01.2024
Medical Authorization Specialist
Accredo Specialty Pharmacy
01.2021 - 01.2023
Patient Access Representative
Texas Vista Medical Center
01.2018 - 01.2021
Patient Financial Services Representative
Conifer Health
01.2016 - 01.2018
Lincoln Academy High School
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