Derivious Moore
Atlanta
Summary
Professional in healthcare industry with strong background in managing authorizations and ensuring compliance. Skilled in navigating complex systems, problem-solving, and maintaining accurate records. Known for effective collaboration, adaptability, and delivering results in fast-paced environments. Reliable team player with expertise in healthcare regulations, communication, and customer service.
Overview
12
12
years of professional experience
Work History
Authorization Specialist
Wellstar Healthcare System
Atlanta, GA
05.2023 - Current
- Reviewed and processed authorization requests in compliance with regulatory guidelines.
- Collaborated with healthcare providers to resolve discrepancies in patient information.
- Implemented process improvements to enhance accuracy of authorizations.
- Trained junior staff on authorization protocols and system navigation.
- Managed complex cases requiring in-depth knowledge of insurance policies and procedures.
- 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.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Assisted in training new team members on company policies and procedures for handling authorization requests.
- Ensured prompt resolution of denied claims through comprehensive analysis of denial reasons and timely submission of necessary documentation for reconsideration or appeal.
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
Customer Service Advocate
Centene Corporation
Atlanta, GA
01.2023 - 04.2024
- Performed as the advocate to support the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supported the utilization management team to document authorization requests and obtain accurately and timely documentation for services related to members healthcare and eligibility and access.
- Provided exceptional support to members by resolving inquiries and facilitating access to services.
- Identifies authorization issues and provided physicians with authorization statuses. Provided connection between provider to clinical reviewer through peer to peer processing. Schedule member appointments for pre-services. Comprehension of patient charts and verified insurance benefits.
- Supports the authorization review process by setting up peer to peers, escalating denials, and submitting claim information. Document and research medically necessary information such as history, diagnosis codes, cpt codes and prognosis based on clinical reviewer determination.
Customer Care Operator
Amazon Prime
Atlanta, GA
01.2019 - 01.2022
- Performed packs and loads of customer products onto vans before delivering orders to customers on predetermined routes.
- Adhered exactly to the route and delivered each order on time and with a high level of professionalism.
- Trained new team members on operational procedures and customer engagement techniques.
- Analyzed customer feedback trends to identify areas for improvement in service protocols.
Customer Service Operations Manager
Sodexo/American Airlines
Atlanta, GA
01.2016 - 01.2019
- Coordinated with General Manager on daily operations by determining opportunities, directing staff, covering zones, fulfilling administrative functions, and maintaining inventory.
- Supervised a diverse team, cultivated a positive culture, and ensured employees reached their full potential through constant evaluation, coaching and training.
- Led customer support teams, enhancing service quality and efficiency through targeted training initiatives.
- Developed processes to streamline complaint resolution, increasing customer satisfaction ratings.
- Trained and regularly mentored associates on performance-oriented strategies and customer service techniques.
Assistant Manager
Arby's
Atlanta, GA
01.2014 - 01.2016
- Supervised a diverse team, cultivated a positive culture, and ensured employees reached their full potential through constant evaluation, coaching and training.
- Ensured food safety and quality of food as well as customer satisfaction. Resolved problems amicably faced by floor staff members and the customers.
- Attempted to de-escalate complex issues in customer service through effective listening and displaying professionalism. Responsible for administrative aspects of the operations while working alongside General Manager to ensure compliance with all organizational policies.
Education
High School Diploma -
Benjamin Banneker High School
Atlanta, GA01.2007
Skills
- Leadership Skills
- Medical terminology
- OMNI Operative Professional
- TruCare Classic/Cloud Operative Professional
- Microsoft office
- Quality control
- EPIC Operative Professional
- Quality Assurance
- Insurance verification
- Data entry proficiency
- Effective communication skills
- Cenpas Operative Professional
- Medicaid
- Eligibility procedures
- Authorizations
- Critical thinking
Timeline
Authorization Specialist
Wellstar Healthcare System
05.2023 - Current
Customer Service Advocate
Centene Corporation
01.2023 - 04.2024
Customer Care Operator
Amazon Prime
01.2019 - 01.2022
Customer Service Operations Manager
Sodexo/American Airlines
01.2016 - 01.2019
Assistant Manager
Arby's
01.2014 - 01.2016
High School Diploma -
Benjamin Banneker High School