Simone Toussaint
Houston,TX
Summary
My name is Simone Toussaint, and I am a dedicated healthcare professional based in Houston, Texas, with five years of experience at Harris Health. I have had the privilege of working alongside a team committed to growth and excellence, where I have cultivated a deep passion for optimizing clinical operations and enhancing patient care. Recently, I became the first and only employee to learn and manage the Clinical Administered Medications (CAM) work queue, showcasing my initiative and commitment to advancing departmental capabilities. I am eager to leverage my expertise to develop and implement effective authorization strategies, contribute to ongoing clinical quality improvements, and foster collaborative relationships with patients, providers, and healthcare partners. With strong communication skills and a steadfast dedication to excellence, I am excited to continue driving success and innovation within the organization.
Overview
6
6
years of professional experience
Work History
Prior Authorization Specialist
Harris Health
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.
External Referral Specialist
Harris Health
07.2021 - Current
- Coordinated with health plans, providers, and patients to obtain referral authorizations, ensuring all necessary approvals were secured to prevent delays in care.
- Maintained open communication with all parties involved, providing timely updates on referral status, authorization requirements, and next steps to streamline care coordination.
- Proactively followed up with insurance companies to resolve authorization issues or coverage discrepancies, advocating for patients to ensure uninterrupted access to care.
- Educated patients and providers on referral procedures, insurance guidelines, and anticipated timelines, fostering clarity and reducing confusion around care transitions.
- Utilized electronic health record (EHR) systems to document referral details, track authorization progress, and ensure all communications were accurately recorded for compliance and continuity of care.
- Identified opportunities for process improvements within the referral department, leading to increased efficiency and accuracy.
Patient Care Coordinator
Baylor Scott and White Hospital
01.2019 - 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
Robinson, TX05-2014
Skills
- Insurance Verification & Eligibility
- Prior Authorization Management
- Referral Coordination
- Communication & Collaboration
- Documentation & Record Keeping
- Problem-Solving & Advocacy
- Time Management & Multitasking
- Knowledge of Payer Requirements
- Proficiency in [Epic]
- Patient Advocacy & Support
- Teamwork and collaboration
- Decision-making
References
- Eric Hobbs
HOT Council of Government
Phone: (254) 214-2699 - Darrell Abercrombie
Waco Community Development Association
Phone: (254) 752-4663 - Tracy Hale, BSN, RN
Harris Health
Phone: (903) 316-7278
Timeline
Prior Authorization Specialist
Harris Health
07.2021 - Current
External Referral Specialist
Harris Health
07.2021 - Current
Patient Care Coordinator
Baylor Scott and White Hospital
01.2019 - 01.2020
High School Diploma -
Robinson Highschool
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