Richanda Harris
Kansas City,MO
Summary
Detail-oriented healthcare professional with expertise in prior authorization, EDI enrollment, and claims processing. Experienced in managing clearinghouse systems, resolving claim rejections, and verifying insurance eligibility across Medicare, Medicaid, and commercial payers. Committed to enhancing provider onboarding and mentoring new team members while contributing to high-quality patient support in a remote role.
Overview
21
21
years of professional experience
Work History
EDI Enrollment Specialist
TriZetto Provider Solutions / Cognizant
10.2021 - Current
- Process and manage provider enrollments for claims, ERA, eligibility, and EFT
- Perform payer ID research and enrollment requirement verification
- Troubleshot and resolved claim rejections and denials, improving claim processing efficiency
- Guided providers through clearinghouse onboarding, enhancing their system navigation experience
- Investigated and resolved billing and payment discrepancies, ensuring accurate financial records
- Assisted in retrieving remittances using secure file transfer protocols (SFTP/FTP) and posting discrepancies
- Managed escalated client calls, addressing complex issues
Transportation Specialist / Driver
KCTG (Kansas City Transportation Group)
01.2014 - 01.2019
- Delivered transportation services for VA hospital contracts, ensuring timely and reliable transport for patients
- Transported elderly and disabled passengers safely
- Coordinated and optimized transportation routes for school services, improving punctuality and accessibility for students
- Provided tailored transportation support for special needs children, ensuring their unique requirements were met
- Addressed inquiries and resolved issues to improve customer satisfaction and foster positive relationships
- Maintained schedules and safety compliance
Prior Authorization Representative
Apria Healthcare
04.2011 - 09.2013
- Processed prior authorizations for durable medical equipment (DME), ensuring timely access to necessary oxygen therapy equipment
- Worked with Medicare, Medicaid, and East Coast commercial payers to obtain approvals
- Verified insurance eligibility and benefits coverage
- Evaluated documentation to confirm adherence to payer medical necessity requirements
- Liaised between insurance providers and physician offices to facilitate effective communication and approval processes
- Coordinated with provider offices to confirm oxygen equipment orders complied with Medicare guidelines, minimizing potential reimbursement issues
- Followed up on pending authorizations to prevent delays in patient care
- Maintained compliance with federal and payer regulations
Pharmacy Technician
Lincare
Kansas City, Missouri
02.2005 - 12.2008
- Processed prescription orders accurately and efficiently for diverse patient needs.
- Facilitated the processing of prescriptions for patients
- Maintained accurate medication records and billing to ensure regulatory compliance
- Operated pharmacy software to manage prescriptions and patient records securely.
- Managed filing of prescriptions electronically
- Addressed patient inquiries regarding medications and services
- Provided customer service to patients by answering questions about medications and health-related topics.
Education
Bachelor of Science - Healthcare Administration
Western Governors University
Salt Lake City, UT05-2028
Skills
- EDI Enrollment
- Claims processing
- Insurance Verification
- Claims & Denials
- Prior Authorization
- Revenue Cycle
- Healthcare Systems
- SFTP/FTP
- Compliance Analysis
- Effective communication
- Decision making aptitude
- Client Relations
- Documentation management
Timeline
EDI Enrollment Specialist
TriZetto Provider Solutions / Cognizant
10.2021 - Current
Transportation Specialist / Driver
KCTG (Kansas City Transportation Group)
01.2014 - 01.2019
Prior Authorization Representative
Apria Healthcare
04.2011 - 09.2013
Pharmacy Technician
Lincare
02.2005 - 12.2008
Bachelor of Science - Healthcare Administration
Western Governors University