Shalorah Thomas
Orange
Summary
Dynamic Financial Analyst with expertise in prior authorization and CPT/ICD-10 coding at Morristown Medical Center. Proven ability to optimize workflows and enhance patient eligibility verification processes. Exceptional communication and interpersonal skills foster collaboration with insurance providers, ensuring timely service delivery and improved revenue cycle management. Committed to achieving results in high-pressure environments.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Authorization Specialist II
Atlantic Health System
Morristown
01.2023 - Current
- Review chart documentation to ensure patient meets medical policy guidelines
- Prioritize incoming authorization requests according to urgency
- Obtain prior authorization via payer website or by phone and follow up regularly on pending cases
- Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
- Initiate appeals for denied authorizations
- Respond to clinic questions regarding payer medical policy guidelines
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
- Contact patients to discuss authorization status
- Other duties as assigned
- Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
- Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
- Basic understanding of human anatomy, specifically musculoskeletal
- Proficient use of CPT and ICD-10 codes
- Excellent computer skills including Excel, Word, and Internet use
- Detail oriented with above average organizational skills
- Plans and prioritizes to meet deadlines
- Excellent customer service skills; communicates clearly and effectively
- Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
- Processed patient authorization requests efficiently and accurately.
- Reviewed medical records to determine eligibility for services.
- Communicated with healthcare providers to gather necessary information.
- Managed authorization workflows using electronic health record systems.
- Collaborated with insurance companies to resolve authorization issues.
- Educated staff on authorization policies and procedures regularly.
- Monitored authorization timelines to ensure timely service delivery.
- Assisted patients in understanding their insurance benefits and coverage options.
- Researched patient eligibility, coverage information, and benefit levels.
- Tracked authorization statuses using electronic databases or manual filing systems.
- Performed data entry into various computer systems including but not limited to EMRs and CRMs.
- Coordinated communication between providers, patients, payers, and other departments as needed.
- Verified insurance authorizations with payers via telephone or web-based systems.
- Processed prior authorization requests in accordance with departmental guidelines.
- Created spreadsheets utilizing Microsoft Excel for tracking authorization status updates from payers.
Personal Trainer/ Coach – NCSF CERTIFICATION
Self-employed
Orange
06.2018 - Current
- Junior field internship with “No Body Denied Fitness (NBD) (Spring 2018)
- Senior field Internship with Equinox in Summit, NJ (Jan-March 2019)
- Fitness Program Design for clients.
- For new clients I perform a FMS test (Functional movement screening) to see where the client is physically. This is a way to analyze movement patterns and observe mobility and stability deficits.
- Improve mobility.
- Improve stability.
- Improve Functional movements.
- Implement Conditioning workouts.
- Implement Traditional strengthening workouts.
- Demonstrate how to properly do certain exercises; such as a squat, lunge, pushups.
- Set Fitness goals for clients.
- Recommend a healthy diet.
- Monitor heart rate.
- Perform Group fitness with about 10-15 clients.
- Perform one of one training with clients.
- Designed personalized fitness programs for diverse client needs and goals.
- Conducted fitness assessments to evaluate client strength and endurance levels.
- Demonstrated proper exercise techniques to ensure client safety and effectiveness.
- Provided nutritional guidance to support clients' health and fitness journeys.
- Motivated clients during training sessions to enhance performance and commitment.
- Maintained up-to-date knowledge of fitness trends and techniques through ongoing education.
- Developed marketing strategies to attract new clients through social media and referrals.
- Built strong relationships with clients, fostering trust and accountability in their fitness plans.
- Motivated clients to reach their personal best by providing positive reinforcement.
- Scheduled appointments with clients and communicated effectively with them via phone or email.
- Conducted assessments to evaluate clients' current physical condition, strength, flexibility, and body composition.
- Built and established relationships with members and guests to help in pursuit of fitness goals.
- Maintained records of client's performance data such as weight loss, muscle gain.
- Provided instructions in proper form, technique, and safety when performing exercises.
- Demonstrated safe and proper exercise techniques to clients.
- Created personal training experiences for clients.
- Encouraged clients to take part in activities outside the gym to maintain a balanced lifestyle.
Medical Office Assistant I - Outpatient Chemotherapy & Infusion Center
Atlantic Health System
Summit
10.2019 - 01.2023
- Register and Schedule over 50 Patients per day using EPIC system
- Coordinate with Physicians offices to obtain required information for charts such as history & physical, treatment orders, and lab results
- Obtain Pre- Authorization Prior scheduling patients treatments. When physicians input order within epic, I will send a message to the pre-auth team who will then obtain authorization from the insurance company.
- Verify patients Insurance (using Revrunner, Navinet, etc) making sure insurance is active and up to date.
- Answer phone
- Fax booking sheets
- Scan in patients demographics within epic
- Project: Monthly History and Physical Audits for all five infusion centers.
- Schedule COVID infusions.
- Coordinate with physicians that have Privilege with OMC to schedule patients for blood and chemo transfusion/infusion.
- Checking Chemotherapy Orders.
- Checking In patients.
- Covering when needed at other offsite locations.
- Verifying patients' insurance. And obtaining the appropriate authorization from our prior-authorization team.
- Print BCA every morning (When covering/working Saturdays at OMC)
- Send paper order forms to non-AMG doctors.
- Route doctors' orders to pharmacy to transcribe (when covering at OMC)
- Make sure chemo, blood, therapeutic phlebotomy, and biologic consents are up to date and scanned into epic.
- Make sure required labs are obtained prior to patients coming in for treatments and are scanned in.
Amazing Athlete Toddler Teacher
Overlook Child Care Center (Bright Horizons)
06.2017 - 10.2019
- Makes Lesson fitness Plans for my class
- Schedule parent & teacher Conference with parents (in person or on phone)
- Schedule tour visits with families
- Create Movement matter, Art smart, science rocks activities / lessons plans for students.
- Welcome Conference with parents (in person or on phone)
- Facilitated engaging physical activities for children of various age groups.
- Collaborated with staff to create a supportive and active environment.
- Planned and implemented fitness programs tailored to children's interests.
- Communicated effectively with parents about children's progress and involvement.
- Organized special events to promote physical fitness and healthy habits.
Recreation/ Event Coordinator/ Supervisor/Secretary
Kean University
Union
09.2014 - 05.2017
- Schedule 25+ event staff working per games (basketball, volleyball, soccer (men/women), football, field hockey, lacrosse and baseball games)
- Interview about 200 incoming event staff candidates.
- Manage Social Media pages Instagram, twitter and Facebook. (post game updates: scores and goals)
- Schedule clean up crew: After every event, the event staff and I make sure that everything is broken down, and put into the rightful place.
- Shut off all the light. (stadium and/or basketball court).
- Office schedules, coordinate meetings and visits, organize files, answer phones.
- Input over 200 event staff hours into our Kronos payroll system.
- Coordinated logistics for campus events, ensuring smooth execution and participant satisfaction.
- Developed event timelines and schedules to effectively manage multiple activities.
- Collaborated with vendors to secure services and materials for various events.
- Facilitated communication between departments to align event goals and resources.
- Managed event budgets, tracking expenses and processing invoices for payments.
- Evaluated feedback from participants to improve future event planning processes.
- Created detailed reports outlining event planning progress, timelines, budgets, and other relevant information.
- Created promotional materials to enhance visibility and attendance at university events.
Education
B.S - Exercise science, Physical Education, Health Education
Kean University
Union, NJ05.2019
High School Diploma -
Cicely L. Tyson Community School of Performing And Fine Arts
East orange, NJ06.2014
Skills
- Time management
- CPT coding
- ICD-10 coding
- Prior authorization
- Payroll processing
- Microsoft Word and Excel
- Interpersonal skills
- Communication proficiency
- Decision making
- Customer service and support
- Program design
- Patient eligibility verification
- Insurance collaboration
- Workflow optimization
- Effective communication
- Attention to detail
- Team collaboration
- Microsoft Excel
Certification
Medical Billing and Coding ICD-10 and 11, 04/02/25, CPD Certification services
Timeline
Authorization Specialist II
Atlantic Health System
01.2023 - Current
Medical Office Assistant I - Outpatient Chemotherapy & Infusion Center
Atlantic Health System
10.2019 - 01.2023
Personal Trainer/ Coach – NCSF CERTIFICATION
Self-employed
06.2018 - Current
Amazing Athlete Toddler Teacher
Overlook Child Care Center (Bright Horizons)
06.2017 - 10.2019
Recreation/ Event Coordinator/ Supervisor/Secretary
Kean University
09.2014 - 05.2017
B.S - Exercise science, Physical Education, Health Education
Kean University
High School Diploma -
Cicely L. Tyson Community School of Performing And Fine Arts