SABRINA STEWART
New Orleans
Summary
Results-driven individual with a solid track record in delivering quality work. Known for excellent communication and teamwork abilities, with a commitment to achieving company goals and delivering exceptional service. Passionate about continuous learning and professional development.
Overview
17
17
years of professional experience
Work History
PRIOR AUTHORIZATION REPRESENTATIVE
HOME CARE DELIVERED
12.2023 - Current
- Manage the pre-approval process required by insurance companies for medical services, procedures, and medical equipment.
- Submit prior authorization requests to insurance companies, often including detailed clinical information and diagnosis codes.
- Monitor the status of prior authorization requests from submission through final determination.
- Proactively identify and resolve issues related to denied requests, coverage limitations, or delays in the process.
- Familiarity with medical terminology, diagnosis (ICE-10) codes, healthcare insurance process, and HIPAA regulations.
- Reviews incoming CMN's and medical records for accuracy.
- Effectively process high volume inbound and outbound call center calls on an automatic dialer.
SENIOR CLAIMS REPRESENTATIVE
GENWORTH
07.2022 - 08.2023
- Reviewed and analyzed claims documentation for accuracy and completeness.
- Managed claims processing for diverse insurance products and services.
- Utilized claims management software to track and document claim progress.
- Generated periodic reports summarizing the volume and type of incoming and outgoing claims activity.
- Ensured compliance with all applicable federal and state laws governing health insurance plans.
- Collaborated with cross-functional teams to resolve complex claim issues.
PATIENT ACCESS COORDINATOR & PHARMACY CALL CENTER REPRESENTATIVE
KROGER SPECIALTY PHARMACY
11.2015 - 07.2022
- Coordinated patient registration processes for specialty medications and services.
- Maintained accurate patient records in pharmacy management systems consistently.
- Applied HIPAA privacy and security regulations while handling patient information.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Applied knowledge of payer requirements and utilized on-line eligibility systems to verify patient coverage and policy limitations.
Appeals Specialist
Renaissance One
New Orleans
01.2009 - 09.2015
- Reviewed and processed appeals for healthcare claims efficiently.
- Collaborated with team members to resolve complex appeal cases.
- Analyzed documentation to ensure compliance with regulatory standards.
- Advised customers on best practices for submitting complete documentation along with their appeal requests.
- Analyzed medical records to determine if further information was needed in order to process appeals.
- Acted as intermediary between insurance companies and customers by researching and assessing information to determine claim validity.
- Maintained up-to-date knowledge of applicable laws, regulations, policies and procedures related to appeals processing.
- Ensured all documents are stored securely according to HIPAA standards.
Education
LOUISIANA TECH UNIVERSITY
Skills
- Claims processing
- Patient record management
- Cross-functional collaboration
- Problem solving
- HIPAA compliance
- Benefit coverage
- Electronic records management
- Medical terminology
Timeline
PRIOR AUTHORIZATION REPRESENTATIVE
HOME CARE DELIVERED
12.2023 - Current
SENIOR CLAIMS REPRESENTATIVE
GENWORTH
07.2022 - 08.2023
PATIENT ACCESS COORDINATOR & PHARMACY CALL CENTER REPRESENTATIVE
KROGER SPECIALTY PHARMACY
11.2015 - 07.2022
Appeals Specialist
Renaissance One
01.2009 - 09.2015
LOUISIANA TECH UNIVERSITY