Shanntaqwayla Williams
Tampa,FL
Summary
Expert in prior authorization processes within healthcare, ensuring accurate patient insurance information and securing approvals for medical procedures. Proficient in administrative tasks, documentation management, and facilitating communication among patients, providers, and insurance companies. Recognized for problem-solving skills, attention to detail, and enhancing workflow efficiency.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Amazon Health Services
Lakeland, Florida
02.2025 - Current
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
- Interpreted benefit language in order to determine covered services under each plan type.
- Conducted quality assurance audits of prior authorization processes according to established standards.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Researched clinical criteria and determined eligibility for requested services based on plan provisions.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
Pharmacy Scheduler
Accredo Specialty Pharmacy
Tampa, Florida
11.2023 - Current
- Verified insurance coverage prior to filling prescriptions for customers to ensure proper reimbursement of services rendered.
- Assisted customers with resolving payment issues by researching possible solutions or referring them to appropriate resources.
- Assisted pharmacists with completing medication orders, verifying accuracy of dosage amounts and drug interactions.
- Processed incoming prescriptions by verifying accuracy of information on the prescription form before entering it into the computer system.
- Assisted customers with setting up medication refills and scheduling deliveries.
- Utilized problem solving skills to resolve complex customer inquiries quickly and efficiently.
- Analyzed customer trends through data collected during calls and provided recommendations for process improvements.
Healthcare Coordinator
Maximus Federal Services
Tampa, Florida
08.2020 - 11.2023
- Provided support to physicians by scheduling appointments, arranging laboratory tests and organizing referrals.
- Maintained accurate patient records, including medical histories, test results, treatments and progress notes.
- Managed billing procedures for health services rendered by providers within the facility.
- Collaborated with other healthcare professionals to provide comprehensive patient care.
- Responded to customer emails and phone calls promptly, courteously, and professionally.
- Followed up with customers after issue resolution to ensure their satisfaction with the outcome.
Customer Service Representative
Liviniti
Natchitoches, Louisiana
02.2016 - 08.2020
- Assisted customers with product selection, ordering, billing, returns, exchanges and technical support.
- Answered inbound calls, chats and emails to facilitate customer service.
- Abide by all obligations under HIPAA related to Protected Health Information (PHI).
- Contact customers to respond to inquiries, or to notify them of claim investigation results, or any planned adjustments.
- Refer unresolved customer grievances to designated departments for further investigation.
- Keep detailed records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
- Confer with customers by telephone to provide information about Rx claims processing.
Education
GED -
Brandon High School
Brandon, FL06-2018
Skills
- Insurance verification
- Prior authorization
- Quality assurance auditing
- Attention to detail
- Time management
- Pharmacology
- HIPAA compliance
- Data entry
Certification
- REMS Certified
References
References available upon request.
Timeline
Prior Authorization Specialist
Amazon Health Services
02.2025 - Current
Pharmacy Scheduler
Accredo Specialty Pharmacy
11.2023 - Current
Healthcare Coordinator
Maximus Federal Services
08.2020 - 11.2023
Customer Service Representative
Liviniti
02.2016 - 08.2020
GED -
Brandon High School
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