Shameda Williams
Missouri City,TX
Summary
Talented Prior Authorization Representative with years of implementing strategies to secure authorizations for clinical procedures. Expert delivering continuous clinical quality improvement. Superb influencing skills to communicate with credibility, tact and diplomacy.
Overview
1
1
year of post-secondary education
16
16
years of professional experience
Work History
Prior Authorization Specialist
Accolade
Houston, Texas
01.2022 - Current
- Managed prior authorization requests for Accolade members across health plans.
- Reviewed clinical documentation for medical necessity and payer requirements.
- Coordinated with providers, payers, and Accolade care teams on determinations.
Healthcare Advocate
Transcarent
Houston, TX
06.2019 - 01.2022
- Serve as a trusted advisor to members, helping them understand, access, and navigate medical, pharmacy, and behavioral health benefits
- Reviewed prior authorization requests for health plans and member cases.
- Collected clinical documentation from providers for authorization review and submission.
- Communicated status updates with members, providers, and care team partners.
Medical Supply Specialist
Texas Medical
Houston, TX
03.2018 - 03.2019
- Ensure medical products and sterilized instruments meet regulatory guidelines (such as CMS or Joint Commission standards) and handle product recalls.
- Track high-cost supplies, implants, and equipment usage in electronic medical record (EMR) or inventory systems to support accurate billing
- Monitor stock levels, perform routine counts, set min/max reorder points, and restock shelves in clinical areas and operating rooms.
- Requisition new supplies, inspect incoming shipments for damage or discrepancies, and process returns or vendor credits.
- Pull items for pick lists, build surgical case carts, and deliver medical-surgical products to departments.
Patient Access Representative
UT Physicians
Houston, TX
02.2016 - 12.2017
- Greet incoming patients warmly, verify personal and demographic data, and create or update electronic health records (EHR).
- Confirm active insurance coverage, interpret primary/secondary/tertiary policies, obtain prior authorizations, and verify medical necessity compliance.
- Explain estimated out-of-pocket costs, collect co-pays, deductibles, or pre-payments, post cash payments, and assist patients with financial assistance or payment plans.
- Schedule in-person and telehealth visits, coordinate specialty/ancillary referrals, and manage provider recall/waitlists
- Answer multi-line phones, triage patient or physician inquiries, and coordinate closely with clinical and nursing teams.
Administrative Assistant
Guillory Home Health
Houston, TX
09.2010 - 02.2016
- Handle incoming patient referrals, track hospital discharges, manage pending admissions, and verify insurance, demographics, and physician information.
- Act as the primary contact point for patients, families, field clinicians, case managers, and physician offices
- Coordinate clinician and caregiver visits, manage daily/weekly schedules, and reconcile Electronic Visit Verification (EVV) records or timesheets using software like Kinser
- Process, track, upload, scan, and file Plans of Care (485 forms), physician orders, and clinical charts, following up on unsigned or outstanding paperwork.
- Maintain strict adherence to HIPAA regulations, safeguard confidential patient/employee records, and assist with agency survey or audit readiness
Education
Associate of Science - Nursing
Lone Star College
Houston, TX 10.2017 - 07.2018
Skills
- Prior authorization
- Utilization review
- Authorization submission
- Medical necessity
- Insurance verification
- Claims coordination
- EHR documentation
- HIPAA compliance
- Insurance procedures
- Benefits navigation
- Patient referrals
- Clinical communication
- Quality assurance practices
- Attention to detail
- Time management
- Time management
- Problem solving
- Medical terminology
- Effective communication
- Patient confidentiality compliance
Timeline
Prior Authorization Specialist
Accolade
01.2022 - Current
Healthcare Advocate
Transcarent
06.2019 - 01.2022
Medical Supply Specialist
Texas Medical
03.2018 - 03.2019
Associate of Science - Nursing
Lone Star College
10.2017 - 07.2018
Patient Access Representative
UT Physicians
02.2016 - 12.2017
Administrative Assistant
Guillory Home Health
09.2010 - 02.2016