Ebony Sharp Email & Phone Number

Houston Tx

Completed entry for authorization request received from providers and hospitals regarding new admission, continue stay, readmission, observation and discharge.Answered provider or hospital inquiries regarding patient prior authorization requests, provider network status, and various policy requirements regarding member authorization guidelines within Community Health Choice.Worked closely with UM nurses, ensuring timely completion of all commercial and non-commercial utilization reviews and authorization as assigned.Monitored health and liability claims from start to finish.Verified and documented information on submitted claims.Reviewed policy to determine which charges were eligible for reimbursement.Adjudicated, adjusted, processed, and/or manually priced new Medicaid and Medicare Claims.Verified patient eligibility according to Coordination of Benefits.Negotiated payment to all parties and follow-up to ensure payments are made.Coordinate, document, and process all denied Sleep and DME claims and appeals in a timely manner.Reviewed medical documentations provided by candidates and data entry into the database.Negotiated with third parties and re-filed all rejected claims.Process all payments and post all forms of payments into CRM.Trained New hires.Handled all A/R reports, monthly patient statements and all inquiries regarding claims and outstanding patient balances.Follow all HIPPA guidelines.Served as a liaison between patient, physician, family and insurance.Requested all clinical information from the referring physician to obtain authorization and provided regular status updates.Obtained data required for sleep study authorization and documented them in the database for further processing.Collaborate with the medical team to ensure cost-effective care.Provided patient education.