Sabrina Shepherd
Houston,Texas
Summary
Dedicated candidate aiming for impactful role to maximize education, skills, and experiences in pursuit of growth and advancement opportunities.
Overview
11
11
years of professional experience
Work History
Clinical OperationTechnician
Prime Therapeutics LLC
Remote, MN
10.2023 - Current
- Assessed request approval criteria and accurately entered Prior Authorizations in claims system.
- Generated clinical outcome communications for members and physicians within established timelines.
- Conducted research on calls and emails, performing outreach to obtain necessary UM request information.
- Delivered pertinent clinical information related to UM requests to Pharmacist and Physician.
- Maintained work queue efficiency to meet client-specific turnaround expectations.
- Engaged with Commercial and Medicare sectors according to departmental requirements for effective reviews.
Care Manager
Spectrum Staffing
04.2022 - 08.2023
- Responsible for single point of contact communication with providers and patients in a designated geographical area. Contact insurance companies to perform appropriate benefit investigation(s) and coverage eligibility to support billing process for client.
- If applicable, assist with the prior authorizations with specific attention to detail and accuracy with provided information. Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance programs.
- Provide courteous, friendly, professional and efficient service to internal and external customers including physicians and patients. Work efficiently both individually and within a team to accomplish required tasks. Maintain and improve quality results by adhering to standards and HIPPA guidelines.
- Eligibility authorization and enrollment into Patient Assistance Program(s). Ability to verify insurance requirements to support current billing processes. Demonstrate a firm grasp of medical billing processes communicating knowledge to internal and external customers. Identifying and providing corrective action for medical billing reimbursement support specifically to provider offices.
- Assignment All Care Pharmacy
Remote Benefits Verification Specialist
MMC Staffing
05.2021 - 03.2022
- Make outbound phone contact with various insurance companies, regarding patient’s benefits to very specific benefits for program being administered. Review all patient’s insurance information needed to complete the benefits verification process. Triage cases with missing information to appropriate program associate.
- Verifies patients’ specific benefits and precisely documents specifics for various payer plans including patients’ coverage, cost share, and access/provider options. Identifies any restrictions and details on how to expedite patient access, include documenting and initiating prior authorization process, claims appeals, etc. Completes quality review of work as part of finalizing product. Reports any reimburse trends and delays to management.
- Assignment (Amerisource Bergen - Lash Group)
Customer Care Representative
Burnett Specialists
Houston, TX
04.2020 - 03.2021
- Properly authenticate each caller before verifying or releasing any information, place outgoing calls to and from Veterans regarding compensation and pension exams; verify and modify personal information obtain through scheduling availability and traveling availability of Veterans.
- Confirm or reschedule appointments; Properly modify changes and document information in OMS, Forward calls to staff members in other departments, notify providers of cancellations for appointments scheduled within 72 hours from the time of the call.
- Submit templates and other requests to various individuals and departments within the Agency, explain policies and procedures of VES and the VA to Veterans who are unfamiliar with our company, and inform the purpose of attending required exams, explain approximate time frames for returning reports/documents to the VA, and explain the process for travel reimbursement.
- Assignment - (Veteran’s Evaluation Services)
Records and Imaging Clerk IV
Texas Department of Regulatory and Protective Service
Houston, TX
09.2014 - 03.2020
- The job duties include being the primary facilitator and subject matter expert to ensure that program staff follows policy and procedures of submitting case records to RMG appropriately and timely. Responsible for retrieving stored records when they are needed for case planning, audits, legal issues, studies, reviews, etc. Interact and communicate daily with front line program staff.
- Effectively, perform strong customer service focus by committing to customer satisfaction routinely with other DFPS staff and management. Accurately, process requests for records in a timely manner. Communicate with RMG customers regarding progress and completion of requests for records. Perform repetitive prepping tasks such as collating, sorting, checking, , stamping, copying, scanning , document retrieval and uploading , assembling and disassembling .
- Follow up with customers to obtain additional information when needed, the ability to perform administrative procedures as lead backup additional duties include involves preparing daily reports, problem solving, inventory, monitoring production to meet weekly goal target, attend meetings in absence of lead.
- RMG Records and Imaging Clerk IV
Education
Diploma - undefined
Evan E. Worthing Senior High School
01.1990
Skills
- Communication and Writing skills
- Customer Service with Complaint/ Problem-solving skills
- Data entry
- Intermediate Computer skills with Multiple Systems EMR, Salesforce, RX claims, Microsoft Office Suite
- Analytical skills
- Problem Solving a
- Organizational skills
- Time/Stress Management skills
- Math skills
- Attention to details
- Quality focus and teamwork
Timeline
Clinical OperationTechnician
Prime Therapeutics LLC
10.2023 - Current
Care Manager
Spectrum Staffing
04.2022 - 08.2023
Remote Benefits Verification Specialist
MMC Staffing
05.2021 - 03.2022
Customer Care Representative
Burnett Specialists
04.2020 - 03.2021
Records and Imaging Clerk IV
Texas Department of Regulatory and Protective Service
09.2014 - 03.2020
Diploma - undefined
Evan E. Worthing Senior High School