Shawnieka Robinson
Sacramento,CA
Summary
Talented Prior Authorization Representative with years of implementing strategies to secure authorizations for clinical procedures. Expert delivering continuous clinical quality improvement. Superb influencing skills to communicate with credibility, tact and diplomacy.
Overview
11
11
years of professional experience
Work History
Prior Authorization Coordinator
Capital Staffing Solutions
Sacramento, NM
04.2023 - 12.2023
- Ensured compliance with all applicable federal, state, local laws, rules and regulations pertaining to the area of responsibility.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Identified discrepancies in submitted documents or coding errors that may affect payment or reimbursement.
- Communicated with patients with compassion while keeping medical information private.
- Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
- Created and maintained accurate documentation for all prior authorization activities.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
Benefits Analyst
Healthcare Support Staffing
Sacramento, CA
09.2022 - 03.2023
- Completed day-to-day duties accurately and efficiently.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Coordinated benefits processing, including enrollments, terminations and claims.
- Checked accuracy and completeness of benefits applications and documents.
- Evaluated efficiency and value of current benefit programs and made recommendations for improvement.
Customer Support Specialist
Employment Development Department
Sacramento, CA
10.2020 - 10.2022
- Maintained positive working relationship with fellow staff and management.
- Answered user inquiries to resolve computer software or hardware operation problems.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Responded quickly to customer inquiries, needs and problems.
- Consulted with customers regarding needs and addressed concerns.
- Escalated customer concerns, issues and requirements to supervisors for immediate rectification.
- Read technical manuals, conferred with users, or conducted computer diagnostics to investigate and resolve problems.
Behavior Management Specialist
Collabera
Sacramento, CA
03.2019 - 03.2020
- Guided clients in developing skills or strategies for dealing with problems.
- Identified treatment goals based on individual diagnosis and history.
- Coordinated activities between home life and school life that focused on improving overall student functioning.
- Participated in assessments and visits with patients in various types of settings.
- Documented information for charts, progress reports, assessments and other paperwork within specific timeframes.
- Understood and followed oral and written directions.
- Completed day-to-day duties accurately and efficiently.
Prior Authorization Specialist
Health Net
Sacramento, CA
06.2015 - 01.2019
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Prioritized and organized tasks to efficiently accomplish service goals.
Customer Service Representative
Covered California
Sacramento, CA
05.2013 - 05.2015
- Answered inbound calls, chats and emails to facilitate customer service.
- Enhanced productivity and customer service levels by anticipating needs and delivering outstanding support.
- Presented existing and prospective customers with valuable service or product information to aid in decision-making.
- Developed strong customer relationships to encourage repeat business.
Education
High School Diploma -
Arthur A. Benjamin Health Professions High School
Sacramento, CA06-2011
Skills
- Medical Terminology Knowledge
- Strong Organization
- Insurance Verification
- Patient Referrals
- Data Entry
- Effective Communication Skills
- Workflow Management
- Critical Thinking Abilities
- Insurance Procedures
- Records Maintenance
- Billing Procedures
Timeline
Prior Authorization Coordinator
Capital Staffing Solutions
04.2023 - 12.2023
Benefits Analyst
Healthcare Support Staffing
09.2022 - 03.2023
Customer Support Specialist
Employment Development Department
10.2020 - 10.2022
Behavior Management Specialist
Collabera
03.2019 - 03.2020
Prior Authorization Specialist
Health Net
06.2015 - 01.2019
Customer Service Representative
Covered California
05.2013 - 05.2015
High School Diploma -
Arthur A. Benjamin Health Professions High School
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