SYDNEY S. DANIEL
Smyrna,TN
Summary
My goal is to obtain employment with a dynamic and fast-paced organization in which I can utilize my talents and work ethic, building a successful career while earning funds for continuing my education. Knowledgeable Prior Authorization handling demanding and detail-oriented billing work. Proficient in working with different insurance carriers to achieve timely resolutions to billing concerns. Skilled with CPT codes and EPIC recordkeeping.
Overview
5
5
years of professional experience
Work History
Pharmacy Reimbursement Speciallist
Vanderbilt University Medical Center
08.2022 - Current
- Coordinate needed therapy for patients through vigilant and positive mediation between doctor's office and pharmacy benefits manager/ health insurance.
- Process prior authorizations including medical necessity documentation to expedite approvals and denials, and ensure appropriate follow up was performed.
- Demonstrated knowledge of insurance and medical terminology.
- Act as a clinical resource to referral staff Use Right Fax to obtain prior authorization requests.
- Enter all data entry information for the client to approve or decline Prior Authorization for necessary medication.
- Confirm and correct ICD9 and CPT codes using EncoderPro and books, and conversations with providers, and Access Data Base.
- Coordinated with providers for further authorization, denial, appeals process information.
Enrollment Specialist
American Exchange
10.2021 - 06.2022
- Responsible for the education of clients on their insurance options on the Medicare market
- Communicated effectively via telephone, email and in person with prospective customers.
- Understood and thoroughly explained services provided to customers and potential customers.
- Properly enroll individuals in insurance products in compliance with any governing laws
- Maintain accurate client information in the American Exchange CRM system
- Work and collaborate with colleges in a team-oriented environment
- Consult with case managers about clients to ensure customer satisfaction
- Research and catalogue client information in order to assess the status of the customer and determine the most effective way to assist with their problems.
Document Processor
Automated Health Systems
02.2018 - 10.2021
- Responsible for processing of Medicaid and Tenncare verifications and applications Use the TEDS system for case work and for assisting clients seeking Medicade or Medicare Review documents and applications for accuracy and validation purposes File cases in order to adhere to the document control system Presided over the training of new team members and assisted with their onboarding
Education
Bachelor of Science - Pre Health
Motlow State Community College
Tullahoma, TNHigh School Diploma -
Stewarts Creek High School
Smyrna05.2015
Skills
- Relevant Skills & Products
- Case Management Google Documents Mathematical Proficiency Microsoft Word
- Customer Service Insurance Carrier Portals Microsoft Excel Network Support
- Data Collection iOS & Android Mobile Systems Microsoft PowerPoint Outlook
- Data Entry Leadership Skills Microsoft Project Windows for PC
- Patient Identification
- Healthcare Terminology
- HIPAA Regulations
- Diagnostic Codes
- Review Cases
- Microsoft Office
- Reviewing Patient Information
- 10-Key Data Entry
Timeline
Pharmacy Reimbursement Speciallist
Vanderbilt University Medical Center
08.2022 - Current
Enrollment Specialist
American Exchange
10.2021 - 06.2022
Document Processor
Automated Health Systems
02.2018 - 10.2021
Bachelor of Science - Pre Health
Motlow State Community College
High School Diploma -
Stewarts Creek High School
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