SHAWNA GRAY
Houston,TX
Summary
Dedicated professional with over 10 years of experience in Healthcare, specializing in Medical Billing and Coding. Expertise in CPT and ICD coding, medical terminology, and customer resolution. Proficient in handling confidential information and utilizing tools such as Meditech, PACS, Onbase, EClinical, and various insurance verification platforms.
Overview
16
16
years of professional experience
Work History
Precertification specialist
Cedargate Tech
08.2019 - Current
- Facilitated successful prior authorization processes for patients, improving care accessibility and efficiency.
- Acted as a liaison among providers, patients, and insurance companies to streamline communication.
- Utilized Carelon, Evicore, and Availity platforms for effective prior authorization management.
- Verified benefits for Cardiology physicians, ensuring comprehensive coverage for office visits and procedures.
- Managed complex clinical documentation and insurance policies to support seamless patient transitions.
- Employed strong organizational skills and attention to detail for accurate billing and compliance.
- Maintained up-to-date knowledge of insurance policies to assist in patient inquiries and resolutions.
- Collaborated with clinical teams to ensure timely and accurate submission of required documentation.
Radiology Coordinator/Scheduler
HCA Pearland Medical Center
12.2018 - 08.2019
- Streamlined diagnostic order processing via Right Fax and Email communications.
- Secured authorizations for Medicaid and Medicare patients using multiple online platforms.
- Managed patient tracking system for efficient data entry and retrieval.
- Coordinated outpatient diagnostic testing schedules within Meditech for optimal patient flow.
- Collaborated with Radiology Techs and Physicians to ensure accurate information exchange.
- Generated weekly reports for physicians, enhancing operational efficiency and oversight.
Pre-Authorization Intake Coordinator
Injury Management Organization
05.2016 - 08.2018
- Obtaining order via email or fax to obtain authorization and insurance verification for Worker Comp
- Communicating with Case Manager, Physicians, Facilities and Adjusters
- Entering Multiple authorization in the CAT system
- Managing inpatient and outpatient authorization in the CAT system Review
- Bills for authorization and payment.
Client Service Representative/Billing Resolution
Spectra Cell Laboratories
08.2009 - 04.2016
- Enhanced patient communication via inbound and outbound calls to ensure clarity.
- Maintained accurate customer records through diligent form processing and database updates.
- Validated insurance coverage and secured authorizations from Medicaid and Medicare providers.
- Collaborated closely with sales representatives and physician offices for optimal outcomes.
- Resolved billing issues swiftly, ensuring efficient and effective customer support.
Education
Diploma - Medical Billing and Coding
Sanford Brown College
Houston, TX08.2012
Skills
- Home Care
- Patient Care
- Call Center, Microsoft Office, Office Equipment, Scheduling, Organization Strengths, Insurance verification and knowledge (10 years)
- Home Health
- Cardiology
- Radiology
Timeline
Precertification specialist
Cedargate Tech
08.2019 - Current
Radiology Coordinator/Scheduler
HCA Pearland Medical Center
12.2018 - 08.2019
Pre-Authorization Intake Coordinator
Injury Management Organization
05.2016 - 08.2018
Client Service Representative/Billing Resolution
Spectra Cell Laboratories
08.2009 - 04.2016
Diploma - Medical Billing and Coding
Sanford Brown College