Open To Work
WISH SANON-BROWN
Visante Pharmacy Consulting
McDonough,Georgia
Work Preference
Desired Job Title
Pharmacy Medication Access SpecialistClinical Resource Administrator & Oncology CoordinatorPatient Access SupervisorRegistration Lead – Emergency RoomRegistration Associate – Rehabilitation
Work Type
Full TimePart TimeContract Work
Location Preference
Remote
Important To Me
Career advancementWork-life balanceCompany CultureHealthcare benefitsPersonal development programsWork from home option4-day work week
2
Languages
3
Certification
17
Years of experience
Patient Access and Revenue Cycle professional with 17+ years of experience in insurance investigation, benefit verification, medical necessity review, and prior authorization for specialty medications, antibiotics, chemotherapy, biologics, and radiology modalities (CT, MRI, ultrasound, diagnostic imaging). Strong background in oncology and infusion authorization workflows, denial management, appeals, and coverage analysis across Medicare, Medicaid, and commercial payers. Experienced in leading teams, resolving escalated cases, managing workload distribution, and maintaining high accuracy in CRM/EMR documentation. Skilled in payer communication, financial assistance navigation, and developing compliant workflows, policies, and training materials to support efficient, high‑quality patient access operations.
Work History
Pharmacy Medication Access Specialist
1 Year 5 Months- Managed end-to-end prior authorization and financial clearance processes for major healthcare clients—including Emory University Hospital and Orlando Health—ensuring timely access to specialty medications, infusion therapies, and critical antibiotics.
- Conducted comprehensive pharmacy and medical benefits verification, analyzing deductibles, coinsurance, and out-of-pocket maximums to empower informed patient decision-making.
- Served as a primary liaison for patients and providers, delivering clear authorization status updates and explaining financial responsibilities with accuracy and professionalism.
- Facilitated peer reviews and prepared clinical appeals to overturn insurance denials for specialized treatments, improving patient access and reducing delays in care.
- Facilitated peer reviews and prepared clinical appeals to overturn insurance denials for specialized treatments, enhancing patient access and minimizing delays in care.
- Partnered with billing teams to perform detailed case audits for Emory University Hospital and Orlando Health, ensuring compliance, documentation accuracy, and revenue integrity.
- Coordinated with nursing staff to verify and bill patient contact hours and nursing services, ensuring accurate reimbursement workflows.
- Led team meetings on behalf of management, communicating new operational workflows, insurance updates, and client onboarding requirements to ensure alignment and compliance.
- Supported onboarding and training of new team members, promoting consistent performance and adherence to organizational standards.
- Collaborated directly with the Director to review daily operational goals, track productivity metrics, and optimize team performance across patient access operations.
Clinical Resource Administrator & Oncology Coordinator
3 Years- Managed oncology authorizations, insurance investigation, and payer communication for chemotherapy, biologics, and infusion services.
- Analyzed denial trends and developed appeal documentation to successfully overturn incorrect determinations.
- Acted as a subject matter expert for payer criteria, coverage policies, and medical guidelines.
- Conducted staff training on documentation standards, payer requirements, and regulatory compliance to enhance overall team proficiency.
- Coordinated delegated UM functions while ensuring accurate CRM and EMR documentation to maintain compliance and streamline processes.
Patient Access Supervisor
1 Year- Led teams responsible for insurance verification, precertification, and medical necessity review for hospital admissions and outpatient services.
- Managed daily workload distribution among team members, monitored KPIs, and ensured timely case completion.
- Resolved escalated patient and provider issues, communicating outcomes to leadership to facilitate informed decision-making.
- Delivered training on payer regulations and documentation accuracy, enhancing customer service expectations for team members.
- Facilitated implementation of corrective action plans for compliance, compliance reporting, and workflow updates.
Registration Lead – Emergency Room
1 Year 2 Months- Conducted real-time insurance investigations and authorization reviews for urgent/emergent cases to facilitate timely patient care.
- Assisted case managers in interpreting payer criteria and reviewing documentation, ensuring compliance with insurance requirements.
- Developed policies that enhanced accuracy of insurance verification and medical necessity documentation, reducing discrepancies in patient billing.
Registration Associate – Rehabilitation
2 Years 1 Month- Reviewed therapy orders and Medicaid requirements, ensuring compliance for timely authorization decisions.
- Resolved authorization issues by conducting detailed documentation reviews and effectively communicating with payers.
- Facilitated patient registration processes to ensure accurate demographic data entry.
- Coordinated insurance verification to enhance billing efficiency and reduce claim denials.
- Assisted families in completing necessary paperwork, improving patient experience and satisfaction.
PreCertification Specialist II – Radiology
2 Years 5 Months- Reviewed medical necessity for CT, MRI, and diagnostic imaging to ensure compliance with payer requirements.
- Coordinated peer reviews and compiled appeal documentation for denied radiology services to support patient access to care.
- Acted as SME for precertification and trained staff on payer policies and CMS guidelines.
Medical Office Specialist III
2 Years- Reviewed medical records and clinical documentation to facilitate precertification and appeals outcomes.
- Prepared reconsideration packets with evidence-based rationales to strengthen appeal success.
- Ensured compliance with Medicare, Medicaid, and commercial payer regulations to uphold operational integrity.
Patient Account Liaison II
2 Years 2 Months- Researched medical records, claim documentation, and payer policies to effectively resolve claim denials, improving approval rates.
- Authored clear, concise appeal letters to address and clarify issues raised by beneficiaries and providers, facilitating resolution.
- Ensured compliance with CMS regulations and billing guidelines to uphold quality standards in patient account management.
Front Office Medical Assistant
1 Year 7 Months- Reviewed clinical documentation to secure authorizations for scheduled procedures, facilitating timely patient care.
- Ensured completeness and compliance of medical necessity documentation with payer requirements, supporting reimbursement processes.
- Managed patient scheduling and appointment confirmations to enhance office efficiency.
- Assisted in preparing examination rooms, ensuring compliance with safety and hygiene standards.
- Recorded patient medical histories and vital signs accurately for physician review.
Customer Care Agent – Subject Matter Expert
1 Year 1 Month- Researched ICD-9/CPT codes and medical necessity criteria to ensure accurate service scheduling.
- Guided team on coverage determinations and authorization requirements to support effective patient care.
- Resolved customer inquiries efficiently, ensuring high satisfaction levels and timely follow-up.
- Documented and tracked customer interactions using CRM systems to improve service delivery.
- Collaborated with cross-functional teams to streamline processes and enhance communication.
Education
Associate of Science - Nursing Administration, Health Care Management
Medical Billing & Coding
Skills
TECHNICAL SKILLS: EPIC
IDX
Meditech
NextGen
CareTend
Emdeon
Availity
NaviNet
Palmetto GBA
GAMMIS
CPT
ICD‑10
HCPCS
CMS NCD/LCD
Coverage Manuals
Microsoft Excel
Word
Outlook
PowerPoint
SPECIALTY SKILLS: Prior Authorization Management • Medical Necessity Review • Benefit Verification • Insurance Investigation • Denials & Appeals • Financial Assistance Review • CRM Documentation • Cross‑Functional Collaboration
CUSTOMER & TEAM SUPPORT: Customer Support • Payer Communication • Escalation Resolution • Staff Training • Workflow Optimization
Certification
- HFMA CRCR – Certified Revenue Cycle Representative
- HFMA CSAPM – Certified Specialist Ambulatory Practice Management
- ACDIS CDS – Certified Documentation Specialist
- Certified Notary Public, State of Georgia
CORE COMPETENCIES
- Patient Access Leadership & Workload Management
- Insurance Investigation & Benefit Verification
- Medical & Pharmacy Benefit Coverage Analysis
- Payer Calls, Case Escalation & Issue Resolution
- Financial Assistance & Program Eligibility Review
- CRM Documentation & Case Tracking
- Prior Authorization & Medical Necessity Review
- Denial Management, Appeals & Reconsiderations
- Cross-Functional Collaboration (Pharmacy, Case Mgmt, Finance, Providers)
- Policy, Procedure & Work Instruction Updates
- Reporting: KPIs, Volumes, TATs, Escalations
- Quality Assurance, Documentation Accuracy & Compliance
Languages
Haitian Creole
Native or Bilingual
English
Native or Bilingual
Timeline
Pharmacy Medication Access Specialist
Visante Pharmacy Consulting
04.2025 - CurrentRead More
Clinical Resource Administrator & Oncology Coordinator
Piedmont Infusion Center
04.2022 - 04.2025Read More
Patient Access Supervisor
Children’s Healthcare of Atlanta
11.2021 - 11.2022Read More
Registration Lead – Emergency Room
Piedmont Henry Hospital
09.2020 - 11.2021Read More
Registration Associate – Rehabilitation
Children’s Healthcare of Atlanta
08.2018 - 09.2020Read More
PreCertification Specialist II – Radiology
WellStar Health System
03.2016 - 08.2018Read More
Medical Office Specialist III
CHE Trinity
04.2014 - 04.2016Read More
Patient Account Liaison II
CHE Trinity
01.2012 - 03.2014Read More
Front Office Medical Assistant
Pediatric Associates
06.2010 - 01.2012Read More
Customer Care Agent – Subject Matter Expert
UnitedHealth Group
05.2009 - 06.2010Read More
Everest Institute
Medical Billing & Coding
Read More
Southern Crescent Technical College
Associate of Science from Nursing Administration, Health Care Management
Read More