QUISHA SCOTT
VIRGINIA BEACH,VA
Summary
Results-driven Clinical Insurance Review Team Lead with extensive prior authorization expertise and a proven record of streamlining processes, accelerating approvals, and supporting multimillion-dollar revenue outcomes. Recognized for adaptability, strong leadership, and delivering high-quality training that elevates team performance. A proactive and dependable contributor known for optimizing workflow efficiency and consistently driving high-impact operational results.
Overview
12
12
years of professional experience
Work History
Clinical Insurance Reviewer – Team Lead
US Oncology Network
Norfolk, Virginia
06.2023 - Current
- Lead and mentor a high-performing team of Clinical Insurance Reviewers, improving team accuracy and turnaround efficiency by an estimated 15–20% while maintaining exceptional standards of compliance and patient-centered care across the US Oncology Network.
- Deliver structured onboarding, coaching, and ongoing development, reducing new-hire ramp-up time by 30% and strengthening team competency, productivity, and collaboration.
- Collaborate with supervisors to align team operations with organizational goals, contributing to a notable reduction in authorization-related delays and improving timely access to oncology treatments.
- Spearhead workflow redesign and process improvements, cutting processing delays by up to 25% and increasing insurance review accuracy and consistency across the department.
- Leverage US Oncology Network resources to enhance training quality and compliance, resulting in measurable improvements in team performance, audit readiness, and adherence to payer and industry standards.
- Developed training materials for new staff, enhancing onboarding experience and understanding of review processes.
- Contributed to the development of a knowledge base for common issues encountered during reviews, streamlining future problem-solving efforts.
- Actively sought opportunities for professional development, attending industry conferences and webinars to expand expertise in relevant fields.
- Enhanced team collaboration by regularly providing constructive feedback to fellow reviewers.
- Assisted management with identifying skill gaps among reviewers, developing targeted training programs aimed at boosting overall team performance.
- Sustained high levels of productivity under tight deadlines by efficiently using available resources.
- Led team to meet project deadlines, ensuring tasks were delegated effectively.
Clinical Insurance Reviewer
US Oncology Network
Norfolk, Virginia
05.2022 - 06.2023
- Evaluated clinical documentation, chemotherapy regimens, and treatment plans to determine medical necessity in alignment with payer policies, ensuring timely and appropriate patient access to oncology care.
- Collaborated proactively with physicians and care teams to obtain critical clinical details, reducing delays and supporting successful prior authorization outcomes.
- Navigated and managed multiple insurance portals and payer platforms to streamline authorization workflows for oncology and hematology services, improving processing efficiency and case turnaround time.
- Leveraged US Oncology’s comprehensive training and resources to build advanced expertise in complex coverage criteria, enhancing accuracy and consistency in insurance case management.
- Maintained strong attention to detail while reviewing numerous documents daily, ensuring consistent quality and accuracy.
- Reduced turnaround time for reviews by effectively prioritizing tasks and managing deadlines.
- Actively sought opportunities for professional development, attending industry conferences and webinars to expand expertise in relevant fields.
- Stayed up-to-date on industry trends and best practices, incorporating relevant information into reviews as needed.
- Enhanced team collaboration by regularly providing constructive feedback to fellow reviewers.
- Assisted management with identifying skill gaps among reviewers, developing targeted training programs aimed at boosting overall team performance.
Oncology Patient Navigator
Urology of Virginia
Virginia Beach, Virginia
07.2018 - 04.2022
- Served as the primary patient support specialist, guiding individuals through complex healthcare processes and proactively removing barriers to ensure fast uninterrupted access to care.
- Achieved a 90% prior authorization approval rate, accelerating initiation of treatment and significantly reducing patient wait times.
- Generated $8.8M in revenue by identifying eligible patients, educating them on Provenge therapy, and coordinating the full treatment lifecycle.
- Delivered comprehensive education to patients and caregivers, setting clear expectations, reinforcing care plans, and providing continuous follow-up to support adherence and satisfaction.
- Coordinated closely with apheresis teams and blood collection centers, including the American Red Cross, to manage specialized procedures and ensure seamless scheduling and clinical accuracy.
- Assisted patients in navigating treatment options, fostering informed decision-making regarding urological health.
- Identified process improvement opportunities, implementing solutions that enhanced operational efficiency in patient services.
- Supported patients in managing their mental and emotional well-being through active listening, empathy, and appropriate referrals to specialized care providers.
- Assisted patients in overcoming barriers to care, such as transportation, language, and financial challenges.
- Coached patients on self-advocacy.
- Participated in regular team meetings, huddles, staff meetings and quality improvement projects to improve patient care.
- Educated patients on insurance and healthcare plans.
- Identified barriers when treatment goals not met, treatment plan not followed or important appointments missed and collaborated in redeveloping patient treatment goals.
- Improved patient understanding of treatment plans with clear, compassionate communication.
- Trained new patient navigators, sharing best practices and insights for effective patient support and advocacy.
Benefits and Authorization Specialist - Lead
Urology of Virginia
Virginia Beach, Virginia
10.2013 - 07.2018
- Resolved reimbursement challenges for over 150+ patients per month, including benefit investigations, prior authorizations, claim assistance, and appeals, ensuring consistent access to care.
- Secured authorizations and pre-certifications with a 95% approval rate for treatments, significantly reducing delays in patient care.
- Delivered training sessions to 20+ staff members quarterly, improving team comprehension of payer requirements, enrollment workflows, and compliance updates.
- Collaborated with physicians, patients, and payer representatives to resolve reimbursement barriers, contributing to a 20% reduction in authorization turnaround times through process improvements.
- Collaborated with medical staff to ensure compliance with insurance requirements.
- Trained new team members on authorization protocols and system usage.
- Streamlined workflows, reducing turnaround times for authorization approvals.
- Analyzed trends in authorization denials to identify areas for process improvement.
- Coordinated with insurance companies to resolve complex authorization issues efficiently.
- Developed educational materials for patients regarding insurance coverage and authorizations.
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Prevented delays in care delivery by proactively identifying potential issues during the pre-authorization process and seeking clarification from providers when needed.
Education
Medical Assistant -
Tidewater Technical Institute
Virginia Beach, VA08.2004
High School Diploma -
Ocean Lakes High School
Virginia Beach, VA06-2004
Skills
- Athena
- Athena IDX
- Epic
- IknowMed G2
- Advanced Excel Proficiency
- PowerPoint
- Web Navigation Skills
- Cross-Functional Project Engagement
- Customer needs assessment
- Analytical thinking
- Conflict resolution
- Excellent communication
- Service coordination
- Confidentiality
- Medical Billing
- Medical terminology
- Risk assessment
- Claims management
- Prior authorization processing
- Insurance verification
- Resource information
- Adaptability and flexibility
- Attention to detail
- Microsoft office
- Critical thinking
- Data entry
- Team building and leadership
- Relationship building
- Team collaboration
- Deadline attainment
- Accuracy and precision
Timeline
Clinical Insurance Reviewer – Team Lead
US Oncology Network
06.2023 - Current
Clinical Insurance Reviewer
US Oncology Network
05.2022 - 06.2023
Oncology Patient Navigator
Urology of Virginia
07.2018 - 04.2022
Benefits and Authorization Specialist - Lead
Urology of Virginia
10.2013 - 07.2018
Medical Assistant -
Tidewater Technical Institute
High School Diploma -
Ocean Lakes High School