Shaunice Harris
Phoenix,Az
Summary
Specialize in managing and processing prior authorization (PA) requests for medical treatments, medications, and procedures. Following insurance guidelines and cost control measures, I have experience working in different healthcare settings. My approach is centered on collaboration, ensuring that patients, families, and healthcare teams work together to achieve the best outcome possible. As a dedicated healthcare professional, I am passionate about providing compassionate, high-quality care while fostering a positive patient experience. With a background in healthcare administration, I strive to continuously expand my knowledge and stay up to date with the latest practices and advancements in healthcare.
Overview
8
8
years of professional experience
1
1
Certification
Work History
PATIENT FINANCIAL CLEARANCE REP
Stanford Health Care
Stanford, CA
04.2024 - Current
- Coordinating with clinics for the process of internal referrals and prior authorizations for specialty clinics and surgery
- Resolving referral, precertification and prior authorization to support insurance specific plan requirements for all commercial, government and other payers for both inpatient and outpatient surgery
- Responsible for obtaining current and active eligibility of copays, deductible, coinsurance, and balances
- Pre appointment insurance review and denials recovery functions
- Adherence to quality assurance guidelines
- Responsible for communication with back-office team through interfaced EMR system
Senior Patient Referral Specialist
Valleywise Health
Phoenix, Az
07.2018 - 10.2024
- Coordinating with clinics for the process of internal referrals and prior authorizations
- Responsible for obtaining current and active eligibility of copays, deductible, coinsurance, and balances
- Obtain and input pre-authorization insurance and demographic information in the appropriate system, Verify CPT/ICD-10 codes are valid and billable
- Responsible for communication with back-office team through interfaced EMR system
- Completed skilled administrative work to support all office staff and operational requirements
BUSINESS OPERATIONS SPECIALIST
Arizona State Division of Fee for Service (AHCCCS)
Phoenix, Az
01.2024 - 07.2024
- Create policy, procedures and protocols and distribute to staff
- Communicate and coordinate with employees to include executive operations team
- Onboard and train new employees to ensure that they adhere to standard operating procedures
- Process improvement and projects related to the care management efforts for FFS members
- Manage professional and personal scheduling for Administrative team including agendas and calendars and coordinating complex scheduling and calendar management as well as content and flow of information to management teams
- Serve as the lead for management projects, including research, development and maintenance management resources, processes, desk levels, tracking and reporting of care management outcomes and data
- Monitor day to day operations, report on performance, and recommend improvements when necessary
Case Manager Clinical Care Support Specialist
Arizona State Division of Fee for Service (AHCCCS)
Phoenix, Az
10.2023 - 01.2024
- Process improvement and projects related to the care management efforts for FFS members
- Support Nurse Case Managers and Coordinators with High Needs High-Cost Initiative
- Care management and care coordination support functions
- Monitoring, processing, and distribution of care management referrals, outreach, documentation and follow up as directed
- Researching provider claims and Prior authorization inquiries
- Serve as the lead for care management projects, including research, development and maintenance of PA/UR care management resources, desk levels, tracking and reporting of care management outcomes and data
- Outreach with IHS and non-IHS Facilities to establish and maintain facility contact and data
- Provider inquiries related to PA processes, denials, reconsiderations, and other CMSU assigned task while serving as a back up to CMSU team functions
Precertification and Authorization Rep
Mayo Clinic Hospital
Phoenix, Az
07.2021 - 09.2023
- Coordinating with clinics for the process of internal referrals and prior authorizations for high tech imaging and other specialty clinics
- Resolving referral, precertification and prior authorization to support insurance specific plan requirements for all commercial government and other payers for both inpatient and outpatient
- Responsible for obtaining current and active eligibility of copays, deductible, coinsurance, and balances
- Pre appointment insurance review and denials recovery functions
- Responsible for communication with back-office team through interfaced EMR system
Front Office Associate
OrthoArizona
Gilbert, Az
06.2017 - 07.2018
- Coordinating with physicians for the process of cancellations, additions and corrections
- Responsible for collections of copays, deductible, coinsurance, and balances - Process all charge forms correctly for payment/charges - Verify CPT/ICD 10 codes are valid and billable
- Assist patients with eligibility, referrals, and authorizations
- Posted payments and charges to patient accounts and participated in billing processes
Patient Financial Support Rep
Banner Health
Mesa, Az
10.2016 - 05.2017
- Responsible for scheduling surgical procedures and confirm surgery appointments
- Coordinate surgery scheduling with hospital, vendors, and staff
- Obtain prior authorization for outpatient/inpatient procedures (private insurance/AHCCCS plans) while verify CPT/ICD-10 codes are valid and billable
- Coordinating with physicians for the process of cancellations, additions and corrections for scheduling purposes
- Respond to patient inquiries regarding surgical information and process all charge forms correctly for payment/charges
- Established financial arrangements for self-pay patients
Education
Bachelor of Science - Health Administration
University of Dubuque
Tempe, AZ05.2021
Associate of Arts - General Studies
Mesa Community College
Mesa, AZ12.2019
Skills
- Administrative reporting
- Project Management
- Proficiency in EHR, EMR systems
- Insurance coding (ICD-9/10, and CPT)
- Pre-services, registration, and payment collection
- Insurance verification
- Insurance authorizations and retro authorizations
Certification
- Epic Super User
- Lean Six Sigma White Belt
- Project Management Essentials Certification
Timeline
PATIENT FINANCIAL CLEARANCE REP
Stanford Health Care
04.2024 - Current
BUSINESS OPERATIONS SPECIALIST
Arizona State Division of Fee for Service (AHCCCS)
01.2024 - 07.2024
Case Manager Clinical Care Support Specialist
Arizona State Division of Fee for Service (AHCCCS)
10.2023 - 01.2024
Precertification and Authorization Rep
Mayo Clinic Hospital
07.2021 - 09.2023
Senior Patient Referral Specialist
Valleywise Health
07.2018 - 10.2024
Front Office Associate
OrthoArizona
06.2017 - 07.2018
Patient Financial Support Rep
Banner Health
10.2016 - 05.2017
Bachelor of Science - Health Administration
University of Dubuque
Associate of Arts - General Studies
Mesa Community College
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