Shawn Pride

Responsible for the authorization and pre-certification of services by coordinating and performing activities required for verification and authorization of insurance benefits for services. Proactively identify and communicate the financial resources available to patients. Collaborate with the Appeals department to overturn claims denied as well as the Managed Care Department in contract negotiations. May initiate and perform revenue cycle activities required for pre-registration. Work collaboratively with members of team to provide quality service to proactively support the efforts that ensure delivery of safe patient care and services and to promote a safety environment at Children's Healthcare of Atlanta.

• Coordinates and performs verification of insurance benefits by contacting insurance provider and determining eligibility of coverage, and communicates the status of verification / authorization process with appropriate team members in a timely and efficient manner
• Provides clinical information as needed, emphasizing the medical justification for procedure/service to insurance companies for completion of pre- certification process
• Acts a liaison between clinical staff, patients, referring physician's office and insurance payers by informing patients and families of authorization procedures
• Contacts referring physicians and or / patients to discuss scheduling due to approvals or denials of authorizations

• Examine, process, review documentation, calculate claims for proper adjudication.
• Comply with state laws, policy, and company procedures.
• Assist claimants, providers and clients with problems or questions regarding their claims and or polices.
• Enter Procedure Codes and verify data for computer processing.

• Investigated, managed and resolved an active inventory of claims arising from the personal and commercial lines property market
• Evaluated claim exposure through timely and accurate claim reserve establishment
• Review Insurance plans owned by customers and adjudicate claims based on plan allowances and state laws