Shambresha Phillips
DeSoto,TX
Summary
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease. Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 12 years of managing documentation. Considered team player with exemplary multitasking skills. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
13
13
years of professional experience
Work History
Insurance Verification /Prior Authorization Specialist
Frontera Strategies
05.2022 - Current
- Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.
- Streamlined prior authorization processes by implementing efficient tracking systems.
- Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Assisted in development of departmental guidelines and procedures for prior authorization processes, improving overall efficiency.
- Contributed to high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
- Managed high volume of incoming calls, maintaining professionalism while effectively addressing needs of callers seeking assistance with prior authorizations.
- Conducted regular audits to ensure compliance with regulatory standards and insurance company policies related to approval process.
- Participated in cross-functional initiatives to improve overall efficiency and effectiveness of prior authorization process for all involved parties.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Verified eligibility and compliance with authorization requirements for service providers. Oversees data entry and completion of referral forms/notifications. Obtains insurance pre-authorization for patients and re-authorization of additional treatment. Ensures insurance carrier documentation requirements are met and referral support documentation is filed in patient's medical record.
- Efficiently manages correspondence with patients, physicians, specialists, and insurance companies. Documents pertinent information on referral form and/or in medical record. Ensures practitioners are following standardized guidelines as recommended by evidenced based medicine.
- Works in collaboration with Patient Financial Services to improve Revenue Cycle process. Continually improve work process to enhance service and customer relations.
- Works to improve Managed Care processes, communication, and patient care as it relates to Managed Care. Keeps up with continual changes in health insurance Managed Care arena and communicates those changes as appropriate.
- Performs other duties as assigned.
HEDIS Project Coordinator
The CSI Companies
01.2023 - 04.2023
- Enhanced quality of HEDIS measurements through meticulous medical record abstraction and documentation.
- Ensured timely completion of assigned projects, managing multiple review deadlines simultaneously.
- Improved HEDIS reporting accuracy by conducting thorough field reviews and data validation.
- Improved document organization by accurately indexing and categorizing various types of content.
- Streamlined data retrieval processes with consistent application of indexing standards and best practices.
Logistics Coordinator
Sns Freight Solutions
10.2020 - 01.2023
- Enhanced supply chain efficiency by optimizing shipping schedules and routes.
- Coordinated with suppliers to ensure timely delivery of goods, minimizing stockouts.
- Enhanced customer satisfaction through proactive communication regarding shipment status and addressing concerns promptly.
- Built rapport with clients, fostering long-term relationships that led to increased customer loyalty and repeat business.
Insurance Verification/Authorization Specialist
Women Specialty Surgery Center
08.2011 - 10.2020
- Improved patient satisfaction by streamlining authorization processes and ensuring timely responses to inquiries.
- Enhanced departmental efficiency with thorough knowledge of insurance guidelines and medical terminology.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Reduced processing times by effectively managing high volume of authorizations, referrals, and appeals.
- Maintained compliance with HIPAA regulations, safeguarding sensitive patient information during authorization process.
- Assisted in training new team members on company policies and procedures for handling authorization requests.
- Promoted positive customer experiences by addressing concerns or questions related to authorizations in professional manner.
- Streamlined communication between departments for improved schedule adherence and reduced conflicts.
- Enhanced scheduling efficiency by implementing automated systems and optimizing coordination processes.
- Maintained accurate records of employee time off requests, facilitating fair distribution of vacation days among staff members.
- Utilized advanced software tools like Excel, Outlook, and scheduling-specific platforms to effectively manage comprehensive appointment calendars.
Education
High School Diploma -
David W Carter High School
Dallas, TX05.2005
Some College (No Degree) - Medical Billing And Coding Program
Sanford-Brown Institute
Dallas, TXSkills
- Effective communication skills
- Workflow Management
- Insurance procedures
- Medical Terminology
- Critical thinking abilities
- Prescription Coordination
- Understanding of insurance details
- Billing Procedures
- Records Maintenance
- Physician order verification
- Medical Coding
- Data Entry
- Understanding of medical terms
- Benefit Coverage
- Medicare and Medicaid knowledge
- Patient Scheduling
- Insurance Verification
- Patient Referrals
- Claim research
- Prior Authorization Process
- CPT coding knowledge
- HIPAA Compliance Knowledge
- Claims processing experience
- Medical Office Procedures
- ICD-10 Coding Familiarity
- Teamwork and Collaboration
- Multitasking
- Problem-Solving
- Written Communication
- Eligibility Determination
- Attention to Detail
- Task Prioritization
- Problem-solving aptitude
- Electronic Health Records Proficiency
- Healthcare Regulations Understanding
- Proficiency in Epic
- Spreadsheet tracking
Timeline
HEDIS Project Coordinator
The CSI Companies
01.2023 - 04.2023
Insurance Verification /Prior Authorization Specialist
Frontera Strategies
05.2022 - Current
Logistics Coordinator
Sns Freight Solutions
10.2020 - 01.2023
Insurance Verification/Authorization Specialist
Women Specialty Surgery Center
08.2011 - 10.2020
High School Diploma -
David W Carter High School
Some College (No Degree) - Medical Billing And Coding Program
Sanford-Brown Institute
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