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
7
7
years of professional experience
Work History
Accounts Receivable Specialists
Blue Signal
01.2024 - 09.2024
- Insurance Knowledge: Familiarity with various insurance plans, including Medicare, and private insurances, to effectively manage claims and patient inquiries.
- Communication Skills: Strong verbal and written communication abilities to interact professionally with patients, insurance companies, and healthcare providers regarding account statuses and billing inquiries.
- Problem-Solving Skills: Ability to identify and resolve issues related to billing discrepancies, claim denials, and patient account inquiries in a timely manner.
- Attention to Detail: Strong focus on accuracy in data entry, documentation, and billing processes to minimize errors and ensure proper reimbursement. Proficient in analyzing account data and reports to track payments, outstanding balances, and trends in patient accounts.
- Familiarity with Billing Software: Experience using healthcare billing systems and electronic health records (EHR) to manage patient accounts and streamline processes.
- Time Management: Strong organizational skills to prioritize tasks and manage multiple accounts efficiently within deadlines.
- Team Collaboration: Ability to work collaboratively with other departments, including clinical staff, billing teams, and management, to resolve patient account issues and improve processes.
Pharmacy Reimbursement Speciallist
Vanderbilt University Medical Center
01.2022 - 12.2023
- Prior Authorization Expertise: Proficient in managing prior authorizations for medications and treatments, ensuring timely approval to facilitate patient care and revenue generation.
- Insurance Regulations and Guidelines: Familiarity with various insurance policies, including Medicare, to navigate the complexities of authorization requirements effectively.
- Attention to Detail: Strong ability to meticulously review and prepare authorization requests to ensure compliance with insurance criteria and minimize denials.
- Analytical Skills: Skilled in analyzing clinical data and documentation to support authorization requests, helping to streamline the revenue cycle process.
- Communication Skills: Excellent verbal and written communication abilities to collaborate with healthcare providers, insurance companies, and patients regarding prior authorization processes.
- Problem-Solving Skills: Capable of addressing and resolving issues related to authorization denials, delays, and discrepancies to expedite revenue collection.
- Familiarity with Health Information Systems: Experience using pharmacy management systems and electronic health records to track authorizations and manage patient information efficiently.
- Team Collaboration: Ability to work closely with pharmacists, billing teams, and clinical staff to ensure seamless coordination of prior authorizations within the revenue cycle.
- Time Management: Strong organizational skills to handle multiple authorization requests efficiently, meeting deadlines in a dynamic healthcare environment.
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.
- Participated in regular team meetings to discuss ongoing projects and address any challenges or areas for improvement.
- Managed multiple priorities effectively, often working on several projects simultaneously while meeting all deadlines.
- Conducted thorough quality checks on completed documents, maintaining an exceptional level of accuracy and attention to detail.
- Maintained strict confidentiality when handling sensitive information, adhering to company policies and regulations at all times.
Education
Bachelor of Science - Pre Health
Motlow State Community College
SmyrnaBachelor of Science - Psycology
South College
Knoxville, TN (Self Study)05.2027
High School Diploma -
Stewarts Creek High School
05.2015
Skills
- Healthcare Terminology
- HIPAA Regulations
- Diagnostic Codes
- Review Cases
- Microsoft Office
- Reviewing Patient Information
- 10-Key Data Entry
- Claims Processing
- Accounts Receivable Software
Timeline
Accounts Receivable Specialists
Blue Signal
01.2024 - 09.2024
Pharmacy Reimbursement Speciallist
Vanderbilt University Medical Center
01.2022 - 12.2023
Document Processor
Automated Health Systems
02.2018 - 10.2021
High School Diploma -
Stewarts Creek High School
Bachelor of Science - Pre Health
Motlow State Community College
Bachelor of Science - Psycology
South College
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