SHANTEL MOORE
Healthcare
Garland, Tx,Texas
Summary
Organized professional knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in medical offices, communicating effectively orally and through writing and developing prior authorization workflows.
Overview
6
6
years of professional experience
Work History
Prior Authorization Representative
Remax Staffing - McKesson
09.2021 - 02.2023
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Processed new medication and refill requests for authorization.
- Communicated pertinent information to client's prescribing provider to facilitate quality service.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Verified eligibility and compliance with authorization requirements for service providers.
- Researched denied claims and contacted insurance companies to resolve these issues.
Human Resources Coordinator
Khols Distribution Center
10.2019 - 01.2021
- Answering all internal and external HR- related queries and requests
- Assisting with payroll administration
- Scheduling meetings, events, interviews
- Assist with document maintenance such as employee handbooks, internal resources and informational PowerPoints.
- Handled employee inquiries and complaints regarding policy and benefits issues.
- Assisted with recruitment process by posting job ads, filtering applications, scheduling interviews, assisting in interview process and drafting offer letters.
- Distributed employee engagement surveys to identify areas of improvement.
- Explained employee compensation, benefits, schedules, working conditions, and promotion opportunities.
- Maintained human resources information system and kept employee files up to date and accurate.
Contact Center Representative
Baylor Scott & White Healthcare
06.2019 - 08.2020
- Responds to, and resolves routine inquiries, complaints and concerns through inbound phone calls, emails and electronic requests
- Ensures a positive and exemplary experience with all customers satisfaction and resolution
- Provide accurate valid and complete information to customers by using the right methods and tools.
- Met customer call guidelines for service levels, handle time and productivity.
Patient Case Coordinator
Outreach Health Services
05.2017 - 06.2019
- Completed various administrative tasks such as making phone calls, answering emails and inputting data into systems.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
- Recorded details regarding therapies to keep patient charts updated.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Education
Associate of Arts - Biblical Studies
3BC
Dallas, TX05.2019
High School Diploma -
North Dallas High
Dallas, TX05.2002
Skills
- Multitasking
- Technical Skills
- Effective Communication
- Creativity
- Communication
- Critical thinking
- Organization
- Empathy
- Teamwork
- Electronic Health Records Systems
- Patient Registration
- Medical Terminology
- Referral Tracking
- Registration Paperwork
- Confidential Records Management
- Clinical Messaging
- Patient Interviews
- Electronic Patient Medical Record
- Medical Coding
- Greeting Visitors
- Problem Resolution
- Patient Insurance Authorizations
- Benefit Coverage
- Reminder Calls
- Electronic Records Management
- Billing Procedures
- Invoice Statements
- Intake Interview
- Precertification Requirements
- Patient Scheduling
- Call Transfers
- Explaining Patient Benefits
- Multitasking
- Benefits Verifications
- Patient Profiles
- Eligibility Checks
- Health Insurance Plan Knowledge
- Outpatient Surgery Coding
- Data Entry
- Medical Records Requests
- Customer Experience
- Customer Interaction
- Electronic Refill Request Processing
- Effective Communication Skills
- Tracking Spreadsheets
- Payment Arrangements
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Far and away the best prize that life offers is the chance to work hard at work worth doing.
Theodore Roosevelt
Timeline
Prior Authorization Representative
Remax Staffing - McKesson
09.2021 - 02.2023
Human Resources Coordinator
Khols Distribution Center
10.2019 - 01.2021
Contact Center Representative
Baylor Scott & White Healthcare
06.2019 - 08.2020
Patient Case Coordinator
Outreach Health Services
05.2017 - 06.2019
Associate of Arts - Biblical Studies
3BC
High School Diploma -
North Dallas High