Sade B

Healthcare revenue cycle and payer operations professional with 10+ years of experience across prior authorization, insurance verification, financial clearance, billing, claims and denial prevention, specialty infusion, patient access, and medical customer service. Experienced in researching commercial and government payer requirements, reviewing CPT/HCPCS and ICD-10 information, interpreting ERA/RARC and EOB details, gathering clinical documentation, and resolving authorization and reimbursement barriers before they delay care or affect payment. Strong background working across provider offices, clinical teams, billing departments, case managers, health plans, and patients to clarify requirements, resolve complex account issues, and keep cases moving through the revenue cycle.

Brings a service-focused approach to payer operations and customer success, with an emphasis on clear communication, accurate documentation, thoughtful problem solving, and consistent follow-through.

Authorization Coordinator - Retina Consultants of Texas

(2025-01)

• Manage prior authorization and insurance requirements for retina treatments, including Anti-VEGF medications and Medicare Part B step-therapy requirements. Review clinical documentation, diagnosis information, and HCPCS/CPT details to confirm requests meet payer criteria before submission.
• Research authorization barriers when a treatment cannot move forward as expected, clarify payer requirements, and work with clinical and provider teams to obtain missing documentation or correct information so the request can continue through review.
• Review EOBs, patient balances, contract rates, and related billing information to help identify reimbursement concerns and connect authorization activity with the financial side of the patient account.
• Respond to payer, authorization, and pharmacy-related questions and provide clear follow-up to clinical and administrative teams so they understand the status of the case and what is needed next.

Patient Access Preservice III - Memorial Hermann Hospital

(2020-01 - 2025-01)

• Supported financial clearance for hospital and office-based services by verifying coverage, benefits, network status, and authorization requirements before care. Worked with urgent add-on diagnostic services, surgery, inpatient and outpatient procedures, and advanced radiology where accurate payer research and timely follow-up were essential.
• Served as a connection between front-end patient access and the centralized billing office, reviewing ERA and RARC information to understand denial causes and help identify registration, insurance, authorization, or coding issues that could be addressed before claims were submitted.
• Applied knowledge of CMS requirements, CPT, HCPCS, ICD-10, and DRG concepts when researching accounts and authorization requirements, helping recognize discrepancies that could lead to claim delays, denials, or reimbursement issues.
• Worked directly with health plans, provider offices, clinical departments, and billing teams to research conflicting payer information, resolve clearance barriers, document findings, and communicate the next steps needed for the account.

Customer Service Representative - Memorial Hermann Home Health

(2018-01 - 2020-01)

• Supported patients and provider offices through the home-health intake process by prescreening physician orders, entering patient demographics, reviewing referral information, and helping ensure cases were ready for clinical evaluation and scheduling.
• Triaged higher-acuity referrals including wound VAC care, total knee replacement, colostomy, PEG-tube, and other complex home-health needs, helping route patients for the appropriate skilled nursing or physical therapy evaluation.
• Coordinated initial evaluations and answered referral-status questions from patients, providers, and internal care teams while maintaining accurate information in Homecare Homebase and electronic fax workflows.

Intake Specialist - Healix, Inc.

(2015-01 - 2018-01)

• Managed insurance verification and intake for specialty infusion services, confirming patient coverage and demographics and researching payer requirements before high-cost medications and infusion therapies were provided.
• Reviewed payer fee schedules and reimbursement requirements and worked with HCPCS Level II and CPT codes for immunosuppressants, antibiotic infusions, injections, and self-infusion services delivered in home and office settings.
• Gathered clinical documentation from ordering physicians to support authorization and medical-necessity review, then followed up with case managers, health plans, and provider offices when additional information was needed.
• Helped keep specialty medication cases moving by connecting the insurance, coding, clinical documentation, authorization, and reimbursement pieces of the account and communicating clearly with the teams involved.

Bachelor of Science - Health Sciences - Sam Houston State University