Shereece Wright
Summary
Dynamic Insurance Clinical Reviewer at Texas Oncology with expertise in chemotherapy authorization and patient advocacy. Proven track record in ensuring pathway adherence and regulatory compliance, while effectively communicating with medical staff to resolve reimbursement issues. Skilled in medical necessity review, enhancing patient access to vital treatments.
Overview
10
10
years of professional experience
Work History
Insurance Clinical Reviewer
Texas Oncology
Houston
12.2021 - Current
- Reviews, processes and audits the medical necessity for each patient’s chemotherapy treatment and documentation of regimen relative to pathway adherence.
- Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
- Obtains insurance authorization and pre-certification specifically for chemotherapy services. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
- Research additional or alternative resources for non-covered chemotherapy services to prevent payment denials. Provides a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources.
- Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient*s records.
- Assist in training new team members and direct the work of colleagues.
- Adhere to HIPAA Compliance and Privacy Standards.
- Obtains insurance authorization and pre-certification specifically for chemotherapy services.
- Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
Patient Access Representative
TIRR Memorial Hermann
05.2015 - 03.2020
- Managed patient scheduling, insurance verification, and prior authorizations for urodynamics procedures.
- Coordinated financial estimates and processed payments.
Education
High School Diploma -
Ross Sterling High
Houston, TX06-2006
Skills
- Medical necessity review
- Chemotherapy authorization
- Insurance verification
- Pathway adherence
- Regulatory compliance
- Patient advocacy
References
References available upon request.
Timeline
Insurance Clinical Reviewer
Texas Oncology
12.2021 - Current
Patient Access Representative
TIRR Memorial Hermann
05.2015 - 03.2020
High School Diploma -
Ross Sterling High
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