Sharelle Scott
Somerset
Summary
Resourceful Account Manager with excellent client oversight, issue resolution and relationship-building expertise. Maximized repeat business opportunities and utilized proven prospecting techniques to expand client base. High-level sales cycle knowledge and strong collaborative skills leading to optimum outcomes.
Overview
10
10
years of professional experience
Work History
Claim & Benefits Analyst
Horizon Blue Cross Blue Shield of NJ
03.2024 - Current
- Application of policy and provider contracts to establish method of payment on medical claims
- Determine the status of medical claim and how claim should be paid
- Reviewing charges and benefit plans for mid size groups and individual consumers
- Analyzing dual coverage & Coordination of benefits for member and successfully process claims based on COB methods
- Review procedure & denial codes on claims
- Investigates the validity of medical claims and the amounts.
- Managed relationships with external partners such as insurance carriers and brokers to ensure optimal service levels for both the company and its employees.
- Conducted thorough investigations into benefit-related issues, resolving discrepancies and providing prompt resolutions for employees.
- Evaluated existing benefit policies and recommended improvements based on benchmarking data analysis against industry standards.
Billing & Enrollment Analyst
Horizon Blue Cross Blue Shield of NJ
10.2023 - 03.2024
- Investigates broker, group and individual consumer accounts for outstanding balances of monthly insurance premiums
- Analyzes & reconciles billing data to identify billing issues/errors for brokers, mid size groups and individual consumers
- Ensures the accuracy of billing data, before collecting payment and completing autopay for members
- Ensures consumers are successfully enrolled in a healthcare plan either directly through Horizon BCBSNJ or the NJ Marketplace
- Research and rectify pharmacy coverage if there are errors with consumers receiving medications
- Generates & distributes billing reports, statements and invoices for brokers, mid size groups and individual consumers
- Provides newly enrolled members with ID cards and Certificate of Coverage letters.
Staff Coordinator/Recruiter
Cedarbrook Day Camp
04.2022 - 09.2023
- Achieved stang objectives by recruiting and evaluating job candidates; advising managers; and managing relocations and intern programs
- Established recruiting requirements by studying the organization's plans and objectives and meeting with the CEO to discuss needs of the business
- Gathered and created spreadsheets through SQL for payroll and recruiting budgets to maximize resources
- Produced social media recruiting advertisements, contacted local schools in the neighboring districts for student referrals
- Interviewed all applicants, verified references, compared qualifications to job requirements and determined if applicants should be eligible for hire
- Conducted onboarding and orientations of all new employees
- Improved team productivity with regular communication and progress updates, fostering a collaborative work environment.
- Enhanced operational workflows by maintaining well-organized documentation systems and updating records accurately as needed.
- Collaborated with department heads to develop strategic plans aligning with overall company objectives, fostering a unified approach toward shared goals.
- Participated in workshops and in-service meetings to enhance personal growth and professional development.
- Oversaw scheduling tasks efficiently, ensuring optimal staff coverage during peak times without sacrificing quality of service delivery or exceeding budget constraints.
- Monitored performance metrics consistently and implemented corrective actions when needed, contributing to continuous improvement initiatives.
- Managed budgets skillfully by tracking expenses diligently and allocating resources appropriately based on priority needs.
- Assisted in recruitment efforts, coordinating interviews and managing onboarding activities for new hires effectively.
- Evaluated operational practices and identified improvement opportunities to develop revisions for systems and procedures.
- Collected and analyzed business data from various departments to prepare reports and presentations for management.
- Organized company-wide events that boosted employee morale and cultivated team spirit within the organization.
Small Business Owner/ Operations
Body Achieved Fitness
09.2014 - 05.2023
- Founded Body Achieved Fitness in 2014
- Developed and implemented a business plan that reflected the company's mission and vision
- Conducted market and industry research to identify consumer needs, market trends and area of business to drive growth, profit diversity and inclusion
- Established a loyal customer base by providing personalized attention, addressing concerns promptly, and exceeding expectations.
- Promoted business via social media to generate leads and maximize brand identity.
- Created financial plans and budgets to optimize resources, track expenses, and ensure profitability.
- Performed statistical analyses to gather data for operational and forecast team needs.
- Evaluated sales reports and financial statements to manage cash flow and develop techniques to improve business.
- Increased revenue by implementing effective marketing strategies and establishing strong customer relationships.
- Improved cash flow with diligent accounts receivable management, reducing delinquencies and bad debt write offs.
- Launched new products or services by conducting market research, identifying opportunities, and developing targeted promotional campaigns.
- Participated actively in local community events or organizations as a way to give back while expanding brand visibility and credibility.
- Hired, trained, and supervised staff to maintain high levels of productivity and customer satisfaction.
- Managed purchasing, sales, marketing and customer account operations efficiently.
- Maintained compliance with industry regulations through regular audits and updates of policies or procedures as needed.
- Evaluated competitors'' offerings to identify gaps in the market for unique selling propositions that attracted new clients.
- Advertised products and services online, social media and through traditional campaigns to target ideal consumers.
- Taught Small Business Workshops at Rutgers University.
Revenue Cycle Analyst
Pharmscript Pharmacy
10.2019 - 04.2022
- Responsible for submitting claims to Medicare, Medicaid, and Private Insurances for reimbursement both via electronic and hard copy methods
- Communicated with facilities regarding all items that are non-covered by an insurance that has covered alternatives
- Provided price quotes for medications that fall under the Facility's financial responsibility
- Assisted patient beneficiary and patient power of attorney with concerns and questions regarding billing of copay and coverage gap clarifications
- Resolved all insurance rejections for prescriptions such as refill too soon, Prior Authorization and Non Covered items
- Generated an End of the Month billing invoice for each facility which includes all medications dispensed for each patient during the month and details of how the medications were billed, all payor changes and copays billed to the facility for Medicaid and Medicare patients.
Regional Manager
New York Sports Clubs
04.2014 - 08.2017
- Presented to and consulted with senior level management monthly to discuss business plan
- Managed over 100 sta members across multiple fitness facilities including personal trainers, cleaning sta, membership consultations, lifeguards, group ex sta members, and sales team
- Responsible for business development training and mentoring to general managers, lead trainers, personal trainers and membership consultants
- Responsible for creating recruiting strategies, conducted final interviews, signed o on hiring, implemented orientation and onboarding and continuous education to develop high performing new and existing employees
- Responsible for managing profit & loss statements/revenue/EBITDA budget for locations
- Developed IDP (individual development plans) appropriate for succession for personal trainers interested in growing with the business
- Conducted weekly and monthly meetings for each club to ensure (KPI's) are measured to exceed budgetary goals
- Generated over $300,000 in monthly sales revenue and over 200 personal training packages each month per location
- Partnered with club managers and conducted monthly meetings for sta employees in every department about monthly goals, and expected weekly productivity.
Education
Bachelors of Business -
Kean University
12.2017
Associates of the Arts - Business Administration
University of Hartford
05.2013
Skills
- Data Analytics 101 Linkedin Certification
- SQL and Database
- Recruiting
- Training & Developing High Performing Teams
- Analytical Thinking
- Account Management
- Client Relations
- ICD 10, HCPCS Codes
- NASCO Claims Systems
- TPX Computer Systems
- UI/UX
- Proficient in Kronos Software, Frameworks LTC, Workday, Microsoft Dynamics AX
- Payroll Processing
- HRIS Systems
- Proficient Microsoft Office
- Strong Leadership & Sales
Awards
- Magna Cum Laude 2013
- Sigma Alpha Pi Inducted Member 2013
- Regional Manager Outstanding Performer NYSC Award 2015-2017
References
- Melissa Lewis, Returns Analyst Supervisor, SHI International, 732-882-3001, Melany.Lewis@gmail.com
- Lori Beauregard, Human Resource Director, RCC Consultants, Inc, 732-682-6391, Loribeaux@hotmail.com
- Jazzmin Bethel, Sr. Field & Employee Social Media Manager, Northwestern Mutual, 732-619-4773, Jbethel9@gmail.com
- Jennifer Vega, Care Technician, Oaks Integrated Care, 848-239-9196, Jvega112590@gmail.com
- Kortney Sanders, Charge Nurse, Medemerge, 732-910-2615, Kortneysanders09@yahoo.com
Timeline
Claim & Benefits Analyst
Horizon Blue Cross Blue Shield of NJ
03.2024 - Current
Billing & Enrollment Analyst
Horizon Blue Cross Blue Shield of NJ
10.2023 - 03.2024
Staff Coordinator/Recruiter
Cedarbrook Day Camp
04.2022 - 09.2023
Revenue Cycle Analyst
Pharmscript Pharmacy
10.2019 - 04.2022
Small Business Owner/ Operations
Body Achieved Fitness
09.2014 - 05.2023
Regional Manager
New York Sports Clubs
04.2014 - 08.2017
Bachelors of Business -
Kean University
Associates of the Arts - Business Administration
University of Hartford
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