Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Simone Toussaint

Houston,TX

Summary

My name is Simone Toussaint. I am grateful to be 28 years old. I live in Houston, Texas. I've been a part of the Harris Health Family for nearly four years. While working for Harris Health, I had the opportunity to collaborate with a team that shared my commitment to growth and achievement. However, my ultimate objective is to share and collaborate my experience and knowledge with others to develop and implement strategies for obtaining authorizations for clinical operations. Providing continual clinical quality improvement. Excellent persuasive talents for communicating with credibility, tact, and diplomacy.

Overview

6
6
years of professional experience

Work History

Prior Authorization Specialist

Harris Health
Houston, TX
07.2021 - Current
  • Verified patient insurance coverage, including eligibility, benefits and authorizations for medical services.
  • Responded promptly to inquiries from providers, patients and payers regarding status of prior authorization requests.
  • Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
  • Facilitated communication between providers, payers and health plans regarding prior authorization processes.
  • Identified areas where improvements can be made within the department by analyzing trends in denials and approvals.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.

Patient Care Coordinator

IDEAL MRI
Waco, TX
01.2018 - 01.2020
  • Identified and documented learning achievements by reporting outcomes, performance information and program adjustments used to boost comprehension
  • Submitted prior authorization requests electronically or by phone to payers.
  • Identified opportunities for improvement in existing processes and procedures related to prior authorizations.
  • Spoke to patients upon arrival to determine if personal data or insurance information had changed
  • Organized timely and accurate referrals to help patients obtain health care services and access available resources.
  • Verified documentation methodically to avoid critical errors impacting care delivery and payments for services.
  • Coordinated between patients and healthcare professionals to meet patient needs
  • Accessed patient information through variety of office software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.

Education

High School Diploma -

Robinson Highschool
05-2014

Medical Terminology -

MCC Semi annual billing and coding seminars for physicians

Skills


Prior Authorizations
Team Building-Collaboration
Medical Terminology
Coding

  • Proficiency in [EPIC]

Customer Service
Front desk operations
HIPAA guidelines
Referral verification
Insurance verification
Effective Communication
Customer service
Healthcare operations
Organizational skills
First Aid/CPR

References

  • Eric Hobbs, HOT COUNCIL OF GOVERNMENT, 1514 New Road, Waco, TX, 76705, (254)214-2699
  • Darrell Abercrombie, Waco Community Development Assc., 1624 Colcord Ave, Waco, TX, 76705, (254)752-4663

Timeline

Prior Authorization Specialist

Harris Health
07.2021 - Current

Patient Care Coordinator

IDEAL MRI
01.2018 - 01.2020

High School Diploma -

Robinson Highschool

Medical Terminology -

MCC Semi annual billing and coding seminars for physicians

Similar Profiles

CREATE PROFILE
Simone Toussaint