SHARMINE LOUIS-GENE
Houston,TX
Summary
Dynamic Team Lead Auditor at Davant with expertise in claims processing and conflict resolution. Proven track record of resolving complex medical claims issues, ensuring timely payments, and maintaining accurate patient records. Adept at leading teams and enhancing workflow solutions, driving efficiency in revenue cycle management. Energetic professional with several years of experience in industry. Punctual employee dedicated to following safety procedures and protocols to avoid mishaps. Considered valuable and hardworking employee by supervisors and peers.
Overview
7
7
years of professional experience
Work History
Team Lead Auditor
Davant
10.2021 - Current
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Maintained accurate patient records with diligent data entry and effective communication with healthcare professionals.
Revenue Cycle Specialist
HUMANA
03.2019 - 07.2021
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Review Explanation of Benefits, denial letters, and payor correspondence to classify the type of appeal required.
- Gather, prepare, and review documentation and various forms needed to submit appeals correctly per payor guidelines.
- Engage patients via phone and/or mail to obtain requested information pertaining to the appeal process.
Front/Back Office
Central Florida Heart Center
Orlando, FL
- Answer and direct phone calls professionally.
- Schedule and manage patient appointments.
- Check and return voicemails promptly.
- Timely and regular follow-up with payors regarding status of appeals - Makes routine phone calls and contact to payor/insurance for status and/or discussion of appeal determination or outcome.
- Ability to identify payor issues within the appeal process and discuss potential improvements and workflow solutions with leadership.
Education
Diploma - Medical Office & Billing
Florida Career College
Orlando, FL05.2018
Pharmacy Technician -
Everest University
Orlando, FL02.2014
Skills
- Claims processing
- Clinical documentation review
- Insurance verification
- Claim denial resolution
- Data entry and analysis
- Prior authorization process
- Risk adjustment
- Disability claim underwriting
- Continuity of care
- Revenue cycle management
- Appeals documentation
- Patient record maintenance
- Customer relationship management
- Data analysis
- Team leadership
- Time management
- Problem resolution
- Conflict resolution
Languages
Haitian Creole
Timeline
Team Lead Auditor
Davant
10.2021 - Current
Revenue Cycle Specialist
HUMANA
03.2019 - 07.2021
Front/Back Office
Central Florida Heart Center
Diploma - Medical Office & Billing
Florida Career College
Pharmacy Technician -
Everest University
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