SHANISSIA DERBY
CHARLOTTE,NC
Summary
Experienced with managing intake processes and client relations. Utilizes organizational and interpersonal skills to ensure seamless client onboarding. Knowledge of effective data management and client support strategies.
Overview
21
21
years of professional experience
Work History
PHARMACY INTAKE SPECIALIST
Select Source International
11.2024 - 04.2025
- Temporary Contracted role that included supporting inbound calls from Providers, Members, and Pharmacies.
- Process a variety of requests, inquiries, and transactions via phone and fax.
- Review requests to ensure accuracy
- Support external customers via phone.
- Document all pertinent information related to the call/inquiry, attach supporting information as applicable, and if unable to resolve, route to the appropriate area for follow-up as applicable
- Gather and analyze data to provide feedback to Team Leads on employee development needs and/or specific providers requiring education on prior approval or pre-certification process
- Screen inquiries to determine if authorization is required
- Verify member benefits and eligibility and/or provider setup.
- Maintain and update Service Requests and research incorrect or missing information.
- Triage and assign all incoming inquiries in a timely, efficient manner throughout the day to the appropriate staff.
PRIOR AUTHORIZATION SPECIALIST
Charlotte Gastroenterology & Hepatology Charlotte
07.2023 - 09.2024
- Responsible for obtaining prior approval for 15 providers in two locations, for Radiology procedures, EKG's and Colonoscopies
- Initiating and coordinating peer-to-peer review and or provider courtesy review for cases resulting in denials
- Maintaining the status of referrals while in review and using various payor websites to check approvals
- Communicating with providers and nurses to clarify orders, diagnosis codes, and procedure codes
- Answering incoming calls and patients' questions regarding procedures.
PATIENT CARE COORDINATOR
Avance Care (Midtown)
03.2022 - 07.2023
- Front-end office position in Primary Care office
- Duties include meeting, greeting, and assisting patients promptly and efficiently
- Schedule new patients and update current patients' information in the EMR system
- Schedule and reschedule appointments, as well as coordinate walk-in patients.
- Collect co-pays, deductibles, and coinsurances
- Explain fees, services, and policies to patients
- Assisting patients in accessing their patient portal
- Educate patients on their insurance plans and payments
- Verify benefits and eligibility with various insurance companies, via phone, chat, and payor websites
- Verify if prior authorization is needed for Ultrasound services
- Obtain registration information and create charts in EMS accordingly
- Maintain the front desk and reception area
PATIENT CARE COORDINATOR
Carolina Center for Oral & Facial
11.2021 - 01.2022
- Duties included greeting patients in a polite and professional manner
- Answering phone, retrieving voicemails, investigating, and returning patient calls
- Forwarding calls to the appropriate parties
- Registering patients, scheduling new patient appointments in-person and over the phone
- Rescheduling appointments
- Contacting referring offices for missing documents
- Monitoring and responding to incoming emails
- Chart prep and purge
- Verifying and updating the patient's demographic information
- Scanning various documents into the patient EMR
GLOBAL SERVICE CENTER COORDINATOR
Global Convergence Incorporated Oldsmar, FL
03.2021 - 09.2021
- Responsible for sourcing IT technicians all over the country for various JP Morgan and Chase locations
- Analyzing, updating, and creating spreadsheets utilizing Excel
- Answering inbound calls and troubleshooting technician issues
- Escalating to bank executives when necessary
- Assisting with access to Main Equipment Rooms and Technology Rooms
- Creating work order tickets for various systems
- Documenting the Scope of Work and work completed to close out tickets.
ACCESS OUTREACH SPECIALIST
Atrium Health Kannapolis, NC
12.2018 - 12.2020
- Assisted 300 + callers per week in a fast-paced environment
- Provided clerical support services in all areas of expertise and knowledge
- Routing of incoming phone calls to ensure patients' messages are taken appropriately
- Taking incoming requests for medication refills, labs, and test results, if required
- Assists with patient message call backs and prescription refill requests
- Scheduled various types of appointments for physicians and clinical practitioners
- Relayed test results to patients when deemed appropriate
- Educated and assisted patients with evolving COVID instructions, information, and testing procedures.
HOSPITAL PATIENT SERVICE CLERK
Upstate Medical University, Syracuse, NY
07.2004 - 08.2018
- Verified demographics and insurance information to register patients in Epic
- Obtained necessary signatures for privacy laws and consent for treatment
- Applied HIPAA Privacy and Security Regulations while handling patient information
- Processed patient responsibility estimate determined by insurance at pre-registration
- Documented and managed patient information
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies, and list of accepted insurance plans
- Organized and maintained records by updating and obtaining both personal and financial information from patients
- Utilized customer service skills and detailed system knowledge to support hospital and clinic operations
- Educated patients and families on treatments, procedures, medications, continuation of care and community resources
- Accessed patient information through a variety of office software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations
Education
Some College (No Degree) - Communication Studies
SUNY College At Oswego
Oswego, NY12.2025
Skills
- Data Entry
- Confidentiality
- Scheduling
- Problem Resolution
- Communication
- Critical Thinking
- Customer Service
- Payment Processing
- Prior Authorization
- EMR Systems
- Insurance Verification
- Patient Registration
- Excel
- HIPAA Compliance
- Epic
- NHK
- Care Radius
- PrimeTherapeutics
Timeline
PHARMACY INTAKE SPECIALIST
Select Source International
11.2024 - 04.2025
PRIOR AUTHORIZATION SPECIALIST
Charlotte Gastroenterology & Hepatology Charlotte
07.2023 - 09.2024
PATIENT CARE COORDINATOR
Avance Care (Midtown)
03.2022 - 07.2023
PATIENT CARE COORDINATOR
Carolina Center for Oral & Facial
11.2021 - 01.2022
GLOBAL SERVICE CENTER COORDINATOR
Global Convergence Incorporated Oldsmar, FL
03.2021 - 09.2021
ACCESS OUTREACH SPECIALIST
Atrium Health Kannapolis, NC
12.2018 - 12.2020
HOSPITAL PATIENT SERVICE CLERK
Upstate Medical University, Syracuse, NY
07.2004 - 08.2018
Some College (No Degree) - Communication Studies
SUNY College At Oswego
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