Summary
Overview
Work History
Education
Skills
Timeline
Generic

Deshannah Harris

Virginia Beach

Summary

Experienced Medical claims processor prior authorization and Long Term Skilled care facilities Denials excellent reputation in resolving problems and improving patients satisfaction driving overall operation improvement with saving cost in various health care environments.

Dependable professional with track record of success in field, attention to detail and proactive mindset. Seeks opportunities to improve processes and workflows for team benefit. Conscientious, hardworking and excels at multitasking in fast-paced environments.

Strategic professional in business operations known for high productivity and efficiency in task completion. Specialize in process optimization, project management, and data analysis, ensuring streamlined workflows and enhanced operational efficacy. Excel in communication, problem-solving, and leadership, leveraging these soft skills to drive team success and achieve organizational goals.

Analytical professional with technical knowledge and critical thinking skills to thrive in data-driven environments. Tackles challenges with positivity and drive to overcome. Works great alone or with others and consistently exceeds expectations.

Adaptable professional with a quick-learning ability and a talent for adjusting to new environments. Skilled in rapidly acquiring new knowledge and applying it effectively. Driven by a passion for continuous learning and successfully navigating change.

Experienced and dependable general worker with a proven track record of efficiently completing tasks in various settings. Skilled in manual labor, equipment operation, and maintaining a clean and organized workspace. Safety-conscious with a strong work ethic and the ability to adapt to different environments. Ready to contribute to a dynamic team and make a positive impact.

Experienced professional with a strong background in technology-related roles. Proficient in software development, system administration, and technical support. Skilled in problem-solving and optimizing performance. Capable of managing projects and collaborating effectively with teams. Committed to continuous learning and staying current with industry trends to contribute to organizational success.

Overview

11
11
years of professional experience

Work History

Utilization Correspondence Rep I- Post Decisions Support

Carelon/My Nexus
12.2022 - 12.2024
  • Processing Denials for Compliance and Completeness for Submission
  • Adding reimbursement structure for Denials that are missing
  • Making calls out to Servicing and Referring Facilities to get clinical information to fax an authorization determination letter
  • Review a CMS citation SNF, IRF & LTACH for typographical errors
  • Fax Denial Authorization Determination Letter to Post Acute care/Servicing Providers
  • Review of Peer-to-Peer Communication to Obtain additional information for determination
  • Listen to calls/voicemail for quality check for return fax number
  • Able to Meet Deadlines effectively with Turnaround times able to handle high volume demands
  • Utilize Clinical Knowledge and analytical skills to review Clinical Documentation for Multiple Insurance Companies

Utilization Review Management Rep II

Elevance Health
07.2019 - 12.2022
  • Manage incoming calls and/or incoming fax requests for authorization of services
  • Determine contract and benefit eligibility
  • Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
  • Refer cases requiring clinical review to a Nurse reviewer
  • Identification and data entry of referral requests into the UM system in accordance with the plan certificate
  • Respond to telephone and written inquiries from clients, providers and in-house departments
  • Participates in GBD Call Quality Program and Departmental metrics
  • Authorizes notification services
  • Checks benefits for facility-based treatment
  • Assist with Medicare Sorting
  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer request and questions are handled appropriately and in a timely Manner
  • Action gram E.G for claims data, and utilization data
  • Subject matter expert/ Follow up for new hire classes along with debriefing/ provide and research when assistance is needed
  • Lead Training classes on daily processing

HEDIS- Pursuit Team Virginia & Georgia

Anthem
01.2019 - 05.2019
  • Contacted provider practices to retrieve medical records
  • Verified information, transferred PHI information, scheduled onsite visits if needed
  • Met deadlines reviewed and charted abstraction portion of Hedis
  • Microsoft Outlook, Excel, Word Right Fax, Verscend program
  • Delivered excellent customer service and professionalism
  • Sent measures out to providers offices
  • Requested information from provider to correct invalid or missing patient medical records
  • Informed provider what medical documentation is missing from member record request

Provider Relations Representative

Optima
05.2017 - 01.2019
  • Assisted with processing of claims
  • Submitted CMS 1500 forms
  • Denial of claim explanations
  • Pre-authorizations in Symphony database
  • Provided member services
  • Sent remittances for provider claims
  • Utilized Macess, Wintegrate, & CSC systems
  • Provided member information regarding health care plan processing information
  • Credentialing for providers to become in network with health plan
  • Received inbound calls from members handling plan issues

Medical Receptionist

Norfolk Health & Rehabilitation Norfolk
09.2015 - 05.2017
  • Operated a busy Front desk
  • Answered calls on a main switch board telephone for 5 providers
  • Faxed over orders and faces sheets
  • Made overhead pages, filed patient’s paperwork
  • Sent faxes & emails, made bank deposits
  • Sent out statement and collections letters
  • Wrote up care plans for Care plan Meetings Regarding Patient Needs
  • Verified Medicaid coverages
  • Ordered supplies for the Medical staff
  • Reviewed demographics for a patient
  • Maintained detailed Patient Logs and Billing Records

Customer Service Associate

Walmart
07.2013 - 09.2015
  • Operated a cash register
  • Greeted Customer
  • Cashed Payroll Checks, Money Orders, and Money Gram
  • Answered questions in reference to online orders

Education

Medical Billing Coding Diploma -

Centura College
Norfolk, VA
01.2011

Standard Diploma -

Bayside High School
Virginia Beach, VA
01.2006

Skills

  • Denial management
  • Authorization processing
  • Clinical documentation
  • Data entry
  • Conflict resolution
  • Multitasking
  • Regulatory compliance
  • Analytical skills
  • Time management
  • Problem solving
  • Team collaboration
  • Performance improvement
  • Records management
  • Goal-oriented mindset
  • Data entry proficiency
  • Excellent communication
  • Analytical thinking
  • Performance management

Timeline

Utilization Correspondence Rep I- Post Decisions Support

Carelon/My Nexus
12.2022 - 12.2024

Utilization Review Management Rep II

Elevance Health
07.2019 - 12.2022

HEDIS- Pursuit Team Virginia & Georgia

Anthem
01.2019 - 05.2019

Provider Relations Representative

Optima
05.2017 - 01.2019

Medical Receptionist

Norfolk Health & Rehabilitation Norfolk
09.2015 - 05.2017

Customer Service Associate

Walmart
07.2013 - 09.2015

Medical Billing Coding Diploma -

Centura College

Standard Diploma -

Bayside High School
Deshannah Harris