Summary
Work History
Education
Skills
Timeline
Generic

Shantel Rose-Lenzy

Missouri,TX

Summary

Passionate and self-driven health-care professional with 13+ years' experience in providing outstanding customer care. Dependable,while serving diverse needs of patients through active communication and responsive engagement with healthcare services and policymakers. Skilled at analyzing case files and databases to speed up inquiry response times and guide information through appropriate personnel channels. Maintains highest standards of ethics, professionalism and regulatory compliance to ease common stressors and de-escalate potential conflicts.

Work History

Ambulatory Service Rep/ Department Support Spc

Kelsey Seybold Clinic
05.2022 - Current
  • Aiding between 20-100 patients daily in friendly and courteous manner
  • Responsible for check-in and check-out functions, including registration and cashiering.
  • Must maintain neat and professional appearance with organized work area.
  • Assisted in calling patients to collect payments for procedures.
  • Schedule minor procedures for Pain and Spine
  • Go over Procedure Guidelines
  • Reach out to patients with scheduling etc.

Prior Authorization Technician

CVS
09.2020 - 04.2022
  • Supports comprehensive coordination of Medicaid and/or Medicare pharmacy services including intake and processing of pharmacy authorization requests
  • Promotes and supports quality effectiveness of healthcare and Pharmacy Services
  • Evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines
  • Evaluates and authorizes approval of pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria
  • Determines appropriateness for medications.
  • Communicates decision to physicians, physician's office staff, medical management staff, members, and/or pharmacists.
  • Will perform clinical research to support request
  • Performs non-medical research including eligibility verification, COB, and benefits verification
  • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
  • Process requests in compliance with various laws and CMS regulations and company policies and procedures
  • Communicate with Aetna Case Managers, Health Plan Staff, External
  • Pharmacies and Health Care Providers
  • Promotes communication, both internally and externally, to enhance effectiveness of medication therapy management services
  • Sedentary work involving significant periods of sitting, talking, hearing, and keying.
  • Escalates requests to Pharmacist when request requires extensive clinical review or denial.
  • Proved successful working within tight deadlines and a fast-paced environment.

SR BENEFITS ADVOCATE

United Healthcare
10.2016 - 10.2019
  • Providing outstanding customer service by making sure members issues are handled within call and/or making appropriate call back to ensure members issue resolved
  • Ensuring that members have all necessary information regarding medical, dental, vision & or mental health benefits for Medicare and Medicaid members.
  • Make proactive calls to members or providers for purposes of ensuring all compliances are being met and member receives best care possible
  • Performing health risk assessments and referring member to internal programs as necessary & welcoming newly enrolled members to health plans.
  • Partnering with appropriate departments/providers to enhance member satisfaction to resolve any member issues
  • Working to ensure maximum accuracy by following all necessary policies procedures
  • Initiate Prior Authorizations for medications and procedures.
  • Intake Coordinator assuring authorizations and clinical information has been processed or received.
  • Worked effectively in fast-paced environments.

Patient Access Representative-SME/Team Lead

Xerox
03.2014 - 05.2016
  • Responsible for verifying eligibility for Medicare Part-D benefits.
  • Responsible for processing written prescriptions/ requests for RX refills
  • Responsible for consulting with customers regarding medication requests &concerns
  • Obtained clinical information and all medical necessities for medications in question.
  • Followed all CVS(Caremark) and CMS guidelines for approval of medication.
  • Contacted providers with authorization requests, regarding denied and appealed process information
  • Assist with Quality Control to ensure all prescriptions are processed in timely manner.
  • Extensive use in ICD-10 and CPT codes to ensure all RX claims processed accurately.
  • Mentored and guided employees to foster proper completion of assigned duties.

Education

Diploma -

Pharmacy Technician Brown College
08.2010

Willow Ridge High School
Houston TX
06.2008

Skills

  • HIPAA Regulations
  • Insurance Authorizations
  • Deductible Collection
  • Benefits Explanations
  • Claims Handling and Coverage Verification
  • Insurance Form Processing
  • Scheduling
  • EPIC
  • Ambulatory healthcare services
  • Personal service experience
  • Customer service standards

Timeline

Ambulatory Service Rep/ Department Support Spc

Kelsey Seybold Clinic
05.2022 - Current

Prior Authorization Technician

CVS
09.2020 - 04.2022

SR BENEFITS ADVOCATE

United Healthcare
10.2016 - 10.2019

Patient Access Representative-SME/Team Lead

Xerox
03.2014 - 05.2016

Diploma -

Pharmacy Technician Brown College

Willow Ridge High School

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Shantel Rose-Lenzy