Quanisha Simmons
Duluth,GA
Summary
High-performing Healthcare professional with extensive experience helping patients and clients with access to healthcare services and day-to-day tasks. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions advancing organizational goals, and providing compassionate treatment to patient communities.
Overview
12
12
years of professional experience
Work History
Elder Care Consultant
Workplace Options
11.2024 - Current
- Assessed elderly clients' physical, cognitive, and emotional needs to develop comprehensive care plans tailored to their individual situations
- Successfully placed numerous clients in appropriate senior living facilities based on their needs and budget constraints
- Provided ongoing support to families by educating them on elder care options, navigating healthcare systems, and advocating for their loved ones
- Presented educational seminars to community groups regarding elder care planning and available resources
- Collaborated with healthcare providers to ensure coordinated care and seamless transitions between care settings
Health Services Specialist
Amida Care
01.2020 - 04.2024
- Obtained member credentialing information for all initial and re-enrolling applicants including verification of HIV and homeless status data in accordance with company policies and guidelines, state regulations and procedures to support network and credentialing processes
- Handled a high volume of inbound/outbound calls; assisted members with various clinical inquiries ensuring member satisfaction
- Generated service need reports to determine necessary information to complete hospitalizations, discharges, treatment, pharmaceutical adherence, and Primary Care Physician outreach
- Facilitated daily rounds to review high utilizer patients to assess members physical and behavioral health needs to indicate current risks and prevent overuse of plan funds
- Provided referrals for planned members to receive case management services
- Collaborated with multidisciplinary teams during case conferences discussing optimal approaches towards individualized care plans
Benefit Verification Specialist
Rogers Behavioral Health
01.2022 - 06.2023
- Responsible for verifying insurance coverage including benefits, eligibility and coverage levels
- Completed all data fields in EHR system (Cerner) with insurance benefit information, including risk entity, estimated Out-of-Pocket expenses, deductible met, authorization start & end dates
- Managed high-volume caseloads approx
- 25-30 benefit checks daily while maintaining strict deadlines for completing benefit verifications and authorizations
- Streamlined pre-service financial clearance processes, expediting access to care for patients in need of urgent medical intervention
- Facilitated smooth transitions for patients between care providers by coordinating authorizations for outpatient services
- Collaborated with cross-functional teams to address discrepancies in patient information, ensuring accurate billing and reimbursement
- Expedited claim approvals by promptly submitting necessary documentation to insurance providers
Live Your Life Undetectable (LYLU) Program Coordinator
Amida Care
10.2018 - 12.2019
- Intake, reviewed and recorded LYLU member enrollment, RHIO consent and intake assessments into Amida Care systems
- Assessed HIV labs to determine members Viral Load for distribution to perspective department for processing
- Established strategic partnerships with external organizations, expanding program reach and impact
- Performed quality assurance for system bulk intake of Quarterly Attestations
- Reviewed primary care provider LYLU quarterly attestation form to process incentive determination and cash payment
- Led training sessions for staff and providers fostering a knowledgeable and cohesive team environment
- Designed and developed job aides to support follow-through of training in to day-to-day operations
- Handled request for secure file sharing portal in coordination with IT
Waiver Service Provider
Jewish Child Care Association
09.2017 - 10.2018
- Provided one on one skill building focused services to children and youth with moderate to severe emotional and behavioral disorders in foster and residential care, individualizing goals & needs for successful functionality in the home and the community
- Documented all patient information including service plans, treatment reports and progress notes into internal system
- Ensured client well-being by conducting routine wellness checks and promptly reporting any concerns or changes in condition to supervising clinicians
- Mitigated potential crises swiftly using expert de-escalation techniques when working with clients exhibiting challenging behaviors due to mental health or cognitive impairments
- Managed caseloads efficiently while maintaining flexibility to accommodate unexpected changes or urgent care needs among clients served
Office Administrator
Care for the Homeless
01.2016 - 07.2017
- Demonstrated exceptional multitasking abilities while juggling diverse responsibilities, including reception duties and ad-hoc administrative tasks
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors
- Aided in employee onboarding through training new hires on office procedures, software applications, and company policies
- Facilitated office productivity, coordinating personnel schedules, quality assurance and procedural improvements
- Optimized budget management by monitoring expenses, negotiating supplier contracts, and identifying cost-saving opportunities
Research Assistant
Institute for Criminal Justice Ethics, John Jay
02.2013 - 06.2015
- Reviewed extensive data files involving cases of child abuse; coded and compiled data using SPSS
- Used various data extraction techniques to gather data sources, cleaned data files, and defined raw data sets
- Generated reports; conducted qualitative data analyses assessing victim statements
- Contributed to the publication of research articles in peer-reviewed journals, showcasing expertise in various topics
Education
Bachelor of Arts - Forensic Psychology, Criminology
John Jay College of Criminal Justice
New York12.2014
Skills
- Clinical Support
- Claims Processing and Insurance Verification
- Case Management
- Proficient in Microsoft Office
- Salesforce
- Cerner
- Conducting Assessments
- Eligibility Determination
- Clinical Data Entry and Review
- Proficient in Medical Terminology
- Referral Coordination
- Financial Counseling
- Care Planning
- Documentation Proficiency
- Inbound/Outbound Calling
- Report Preparation
- Customer Service
- Interpersonal Skills
- Patient Advocacy
- Healthcare System Navigation
Timeline
Elder Care Consultant
Workplace Options
11.2024 - Current
Benefit Verification Specialist
Rogers Behavioral Health
01.2022 - 06.2023
Health Services Specialist
Amida Care
01.2020 - 04.2024
Live Your Life Undetectable (LYLU) Program Coordinator
Amida Care
10.2018 - 12.2019
Waiver Service Provider
Jewish Child Care Association
09.2017 - 10.2018
Office Administrator
Care for the Homeless
01.2016 - 07.2017
Research Assistant
Institute for Criminal Justice Ethics, John Jay
02.2013 - 06.2015
Bachelor of Arts - Forensic Psychology, Criminology
John Jay College of Criminal Justice
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