Shaunda Randall
Altamonte Springs,FL
Summary
Adding to a job position to match outstanding current employment skills , while becoming an asset to an organization or team that will offer a great employment opportunity.
Overview
12
12
years of professional experience
Work History
Insurance Verification Coordinator
Centene, Acaria Health
01.2020 - Current
- Responsible for patient's coordination of insurance benefits . Running test claims , advising patient of current copay amounts. Maintaining knowledge of diagnosis codes (ICD-10 )
- Enhanced claim processing efficiency by verifying insurance coverage and benefits for patients.
- Provided exceptional customer service to both patients and providers while addressing inquiries related to coverage or authorization status accurately and promptly.
- Collaborated with patient registration team to verify insurance coverage and obtain necessary authorizations, reducing delays in service provision.
- Updated patient records with accurate, current insurance policy information.
- Assist patients with enrolling in copay assistance programs for high cost specialty medications
- Expedited claim approvals with thorough prior authorization submissions and diligent followups.
- Working with team specific to diagnosis and while successfully maintaining productivity and effectiveness
- Provider and member resolution for escalated issues
- Trained new staff on current, correct insurance verification procedures.
- Assisted patients with understanding personalized insurance coverage and benefits.
Economic Self Sufficiency Specialist
Florida Department Of Children & Families
05.2018 - 05.2019
- Interviewed applicants via telephone to obtain and verify information required to determine eligibility for Food Assistance, State Medicaid and Cash Assistance. Advised clients what was needed to approve case.
- Collected and analyzed personal and financial information to make appropriate determinations.
- Looked for signs of fraud and reported cases to fraud coordinator and investigators.
- Determined correct services and program resources for individual needs.
- Reviewed applications to conclude and determine eligibility with approval or denial of applicant's case.
- Performed to maintain daily caseload along with productivity , 35 cases daily.
- Maintained accurate and up-to-date case records, adhering to confidentiality guidelines and regulatory requirements.
Member Services Representative
Optum RX
07.2016 - 08.2017
- Answered average of 35 calls per day by addressing customer inquiries, escalations and providing new drug benefit plan information and updates along with placing medication order requests for members
- Provided authorization for payment of medications, and processing information to medical office providers pharmacies patients and patient client coordinators
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
- Effectively communicated with authorization and appeals departments & medication shipping department
- Successfully maintained required quality metrics with excellence
- Maintained high-quality service by adhering to company policies and standards in all member interactions.
- Assisted members with account management, including updating personal information and setting up automated payments.
Family Advocate
Not Employed
09.2014 - 09.2016
- Assisted adult and child with developmental disabilities with daily life tasks.
- Assisted with Individual Education Plans
- Assisted with therapy
Customer Service Representative
America's Workers Comp RX
09.2015 - 07.2016
- Answered average of 30 calls per day by addressing customer inquiries, solving problems and providing new product information.
- Politely assisted customers in person and via telephone re: authorizations for pharmacy claims. Claimants, doctors office pharmacies & claims adjusters
- Provided pharmacies with authorization for payment of medications for workers compensations patients and clients
- Assisted with processing specialty medication, Dedicated specialty medications coordinator
Intake Specialty Pharmacy Coodinator
Aetna Specialty Pharmacy
11.2011 - 09.2014
- Entered Specialty medication prescriptions into company data base with great detail, accuracy and care.
- Communicated with physicians offices for clarifications on prescriptions.
- Communicated effectively with various departments, including nursing, prior authorization, pharmacist department & customer service.
- Assisted with inbound customer service calls, advised and educated insured about specialty pharmacy benefits problem solving escalated calls.
- Met and exceeded daily productivity and metrics, (top producer) 200 referrals daily.
- Enhanced interdepartmental communication with regular updates and coordination of pharmacy services, optimizing overall healthcare delivery.
Education
High School Diploma -
Oviedo High School
Oviedo, FLCertified Nurse Assistant - Nursing
Cambridge Institute of Allied Health
Altamonte Springs, FLSkills
- Exceptional communication skills
- Multi-line phone talent professionalism
- Medical terminology knowledge
- Local/state health laws knowledge
- patient resolution escalated issues
- Proficient in MS Word, MS Office ,Excel and Outlook
- Insurance coverage verification, including Coordination of Benefits
- Prior authorization processing
- Understanding of medical terms
- Patient member and Provider contact
- Policy Compliance
- Data integrity
- Analytical and Critical Thinking Problem solving
- Provider Experience and resolution
- Collaborative relationships and support
- Knowledge of HIPAA laws
Timeline
Insurance Verification Coordinator
Centene, Acaria Health
01.2020 - Current
Economic Self Sufficiency Specialist
Florida Department Of Children & Families
05.2018 - 05.2019
Member Services Representative
Optum RX
07.2016 - 08.2017
Customer Service Representative
America's Workers Comp RX
09.2015 - 07.2016
Family Advocate
Not Employed
09.2014 - 09.2016
Intake Specialty Pharmacy Coodinator
Aetna Specialty Pharmacy
11.2011 - 09.2014
High School Diploma -
Oviedo High School
Certified Nurse Assistant - Nursing
Cambridge Institute of Allied Health
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