Shafila Rahman

Results-driven healthcare professional with comprehensive experience in patient coordination, insurance authorizations, and revenue cycle management. Adept at navigating payer requirements, improving patient care outcomes, and driving operational efficiency. Skilled in pre-authorizations, eligibility verification, patient billing, claims resolution, and insurance portals, with a proven ability to foster collaborative relationships with patients, providers, and insurance representatives.

Multilingual communicator proficient in EMR/EHR systems, medical coding, and cross-functional team leadership. I have experience working with Emory Healthcare, Northeast Georgia Health System, and Piedmont Healthcare in both inpatient and outpatient settings. In these roles, I supported clinical operations by assisting providers and care teams, helping ensure procedures were completed efficiently and patient care goals were achieved.

Additionally, I support front-end revenue cycle operations including insurance verification, benefits review, authorization processing, patient financial responsibility estimates, and payment collection, working with Gammis, Medicare, and commercial insurance payers to ensure accurate billing, reimbursement, and overall revenue cycle efficiency.

Revenue Cycle Specialist - Digestive Healthcare of GA - Smyrna, GA

(2025-01)

Responsible for supporting the full revenue cycle process including insurance eligibility verification, benefits review, authorizations, patient billing, payment collection, and communication with insurance companies and patients to ensure accurate reimbursement and minimize claim denials.

• Submit and track authorizations through payer portals and authorization lookup tool websites including Medicaid, Medicare, Carelon, Cohere Health, Evicore, Evolent, Quantum Health, Epic RTE, Waystar, Availity, Ambetter, Cigna, Palmetto GBA, Tricare Humana, Humana Military, UHC and UMR.
• Review deductibles, co-insurance, co-pays, and coverage prior to procedures and services.
• Generate estimate letters for self pay patients and communicate financial responsibility to patients.
• Collect patient payments using Clover Team.

Insurance Authorization Coordinator - Georgia Pain and Wellness Center - Lawrenceville, GA

(2024-01 - 2025-01)

• Verify patient insurance eligibility, including deductibles, co-pays, and out-of-network benefits, ensuring accurate determination of service coverage.
• Obtain pre-authorizations for medical treatments, procedures, and tests, securing approvals within payer timelines to prevent claim denials.
• Serve as liaison between patients, providers, and insurance companies, communicating benefit details, resolving discrepancies, and maintaining compliance with HIPAA and payer requirements.
• Prepare, track, and submit detailed authorization requests and maintain meticulous logs of approvals, denials, and pending cases.
• Address complex authorization challenges, troubleshoot provider inquiries, and escalate issues as necessary to support uninterrupted patient care.
• Ensure adherence to state and federal insurance regulations while leveraging EHR systems to optimize workflow efficiency.

Patient Transporter Supervisor - Northeast Georgia Health Systems - Gainesville, GA

(2024-01 - 2024-12)

• Directed daily patient transport operations, ensuring compliance with hospital protocols and timely service delivery.
• Conducted team meetings, monitored attendance/productivity, and provided coaching to improve transporter performance.
• Streamlined dispatch operations and implemented new training methods, increasing efficiency and compliance.
• Elevated patient care standards by resolving transport-related issues with empathy and efficiency.

Patient Care Coordinator - Emory Brain Health Center - Atlanta, GA

(2022-01 - 2024-12)

Managed patient case coordination for durable medical equipment (DME), collaborating with providers to assess needs and secure insurance coverage.

• Obtained authorizations for DME coverage and facilitated referrals, ensuring alignment with treatment plans.
• Delivered patient and provider education on DME protocols, improving outcomes and adherence.
• Maintained accurate records and applied up-to-date knowledge of DME regulations and technology advancements.

Unit Secretary ICU / Unit Assistant ICU - Northeast Georgia Medical Center - Braselton, GA

(2018-01 - 2020-12)

• Coordinated patient admissions and discharges for ICU, ensuring smooth administrative workflows.
• Educated patients and families on discharge care while safeguarding PHI and maintaining HIPAA compliance.
• Supported ICU operations by managing communications, documenting procedures, and overseeing inventory.
• Delivered compassionate support to families during critical and end-of-life care situations.

Patient Service Care Coordinator - Emory Dermatology

• Delivered patient-focused care, receiving consistent positive feedback.
• Enhanced practice reputation through attention to detail and customer service.

Master of Public Health - Environmental Health & Global Health - Emory University (2020-01 - 2022-12)

Bachelor of Business Administration - International Business - Georgia Gwinnett College (2012-01 - 2016-12)