SHARMAINE DAVIS
Orthopedic Surgery Office
Bothell,WA
7
years of professional experience
Oversaw patient support initiatives to resolve complex healthcare claims. ,Enhanced communication strategies between patients and healthcare providers. ,Cultivated a compliant, confidential environment focused on quality patient care.
Work History
Patient Service Representative
3 Months- Provided professional, compassionate front-line service to orthopedic surgery patients by phone and in person.
- Scheduled and coordinated patient appointments, follow-ups, and provider visits while maintaining accurate patient information.
- Verified patient demographics, insurance information, and appointment details to support efficient office operations.
- Communicated with patients regarding appointments, referrals, paperwork, and routine questions, escalating clinical concerns to appropriate staff.
- Maintained patient records and documentation in accordance with office procedures and HIPAA confidentiality requirements.
- Coordinated with orthopedic surgeons, clinical staff, insurance teams, and other healthcare providers to help ensure timely patient care.
- Assisted with referral and authorization-related documentation and followed up on outstanding information as needed.
- Delivered excellent customer service to patients experiencing pain or mobility concerns while maintaining a calm and professional manner.
Government Prior Authorization Specialist
4 Years 4 Months- Processed and verified Medicare Part D claims while ensuring compliance with healthcare requirements.
- Resolved claim rejections by coordinating with providers and patients.
- Maintained accurate patient records and case summaries.
- Collaborated with teams to ensure timely access to medications.
- Streamlined the prior authorization process, reducing patient wait times and improving treatment access.
- Trained and mentored new hires on standard processes and procedures.
Extended Hours Pharmacy Benefit Specialist
5 Months- Handled calls from Commercial and Government lines of business during after-hours coverage.
- Completed and analyzed reports used to support timely claim adjudication.
- Communicated follow-up needs and escalated calls to day-shift teams.
- Provided exceptional customer support to patients navigating pharmacy benefits.
Government Benefit Specialist
10 Months- Handled calls from Medicare, FEHB, Medicaid, and CHIP lines of business.
- Built strong client relationships through clear communication and benefit education.
- Assisted Medicare members with Part D grievance, coverage determination, and appeals processes.
- Participated in projects focused on improving government department processes and systems.
Pharmacy Benefits Specialist I & II
8 Months- Received incoming calls for commercial lines of business and educated callers on plan benefits.
- Troubleshot claims issues for providers and pharmacies by verifying member coverage.
- Promoted from PBS I to PBS II after meeting department standards for statistics, production, and documentation.
- Provided exceptional customer service through active listening and adherence to company procedures.
- Mentored new staff and promoted teamwork in a fast-paced environment.
Education
- Healthcare Coding & Classification
Pharmacy Technician - Pharmacy Technician Certificate
High School Diploma
Skills
Achieved high patient satisfaction scores through effective service and support.
Elevated customer service standards in healthcare to foster patient loyalty.
Facilitated clear communication using medical terminology to enhance team collaboration.
Improved documentation accuracy
leading to better patient outcomes.
Enhanced electronic health records management
resulting in reduced errors.
Boosted patient advocacy efforts
increasing patient engagement.
Strengthened provider communication
leading to improved care coordination.
Accelerated claims processing
reducing delays in reimbursement.
Optimized prior authorization turnaround times
improving patient service.
Increased accuracy in insurance verification
minimizing claim rejections.
Enhanced data management efficiency
contributing to better decision-making.
Achieved full HIPAA compliance
safeguarding patient information.
Navigated healthcare regulations effectively
ensuring organizational adherence.
Incorporated pharmacy terminology training
improving staff competency.
Promoted team collaboration
resulting in successful project completions.
Implemented process improvements that led to significant operational gains.
Timeline
Patient Service Representative
Orthopedic Surgery Office
01.2026 - 04.2026Read More
Government Prior Authorization Specialist
Select Health
04.2021 - 08.2025Read More
Extended Hours Pharmacy Benefit Specialist
Select Health
10.2020 - 03.2021Read More
Government Benefit Specialist
Select Health
01.2020 - 11.2020Read More
Pharmacy Benefits Specialist I & II
Select Health
04.2019 - 12.2019Read More
Weber State University
from Healthcare Coding & Classification
Read More
Broadview Technical College
Pharmacy Technician from Pharmacy Technician Certificate
Read More
Horizante Instructional & Training
High School Diploma
Read More