Sherri Cavada
Trafford,PA
Summary
Achieved promotions within 90 days of hire, demonstrating rapid adaptability and performance excellence. Recognized as Employee of the Month multiple times, reflecting consistent dedication and high-quality work. Collaborated effectively with State and Federal government agencies and commercial insurance providers, enhancing operational efficiency and compliance.
Overview
23
23
years of professional experience
Work History
Insurance Verification Specialist/ RCM
Family Behavioral Resources LLC
Pittsburgh, PA
01.2017 - 06.2024
- Conducted insurance verifications to confirm patient eligibility and benefits coverage
- Reviewed and processed pre-authorization requests to ensure compliance with insurance guidelines
- Collaborated with healthcare providers to obtain necessary documentation for claims submission
- Analyzed discrepancies in patient records and resolved issues related to insurance coverage
- Maintained accurate records of verification activities using electronic health record systems
- Implemented process improvements that enhanced accuracy in verification tasks
- Led initiatives to streamline workflows, reducing turnaround time for insurance verifications
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Enhanced claim processing efficiency by verifying insurance coverage and obtaining pre-authorizations for behavioral development.
- Coordinated with care teams across various departments to ensure seamless integration of verified coverage information into overall treatment planning.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Electronic billing to ensure timely payment
- Entered billing information and payments to receive payment from government and commercial reimbursement
Insurance Investigator
KHI/ PharMerica
Cranberry Township, PA
01.2015 - 01.2017
- Use online resources to submit prior authorizations.
- Submit pharmacy claims for billing. Submit letters of notifications, additional information etc. to nursing homes/assisted living homes.
- Called plans to provide additional information.
Insurance Investigator II / Auditor
Lash Group
Monroeville, PA
01.2010 - 01.2016
- Processed enrollment forms from Doctor’s office.
- Call insurance companies to get benefit information.
- Did prior authorizations, spoke with pharmacies, reported benefits to the patients.
- Helped with projects conducted by the supervisors.
- Work complaint cases.
- Helped co-workers with their cases when needed.
- Worked the appeal process when the prior authorization was denied.
- Help launch new programs.
- Trainer for new hires.
- Worked with other programs. Auditor for 2 medications.
- Answer representative hotline calls.
- Report AE cases.
- Audited all cases for accuracy.
- Listen to calls for monthly audits.
Pharmacy Technician
Norwin Pharmacy
North Huntingdon, PA
01.2009 - 01.2010
- Handled prescription processing and typing.
- Entered data for reports, returns, and inventory.
- Maintained computerized inventory of all supplies and medications.
- Answered the telephone and represented the company in a professional and businesslike manner.
Administrative Assistant
Lorain County Community Action Agency
Lorain, OH
01.2001 - 01.2004
- Administrative support to the Head Start Program.
- Assisted in writing grants.
- Maintained daily information for Federal and State programs.
- Supported Community Action in programs such as Head Start, Weatherization, Human Resources and Senior Care.
Education
Diploma - Business Studies
West Greene High School
Rogersville, PASkills
- Organizational abilities
- Customer engagement strategies
- Software skills
- Information entry
- Phone system operation
- Typing and documentation
- Calculator proficiency
- Filing systems
Timeline
Insurance Verification Specialist/ RCM
Family Behavioral Resources LLC
01.2017 - 06.2024
Insurance Investigator
KHI/ PharMerica
01.2015 - 01.2017
Insurance Investigator II / Auditor
Lash Group
01.2010 - 01.2016
Pharmacy Technician
Norwin Pharmacy
01.2009 - 01.2010
Administrative Assistant
Lorain County Community Action Agency
01.2001 - 01.2004
Diploma - Business Studies
West Greene High School