DeShandra McCullough
Valley,AL
Summary
Versatile customer service professional with 25+ years of experience in healthcare, insurance eligibility, and quality assurance. Skilled in resolving claims, managing eligibility cases, and coordinating virtual care for Medicaid and commercial plans. Adept at HIPAA-compliant documentation, high-volume call management, and cross-functional collaboration. Recognized for delivering empathetic, solution-driven support that boosts patient satisfaction, improves operational efficiency, and strengthens retention in both clinical and remote environments.
Overview
26
26
years of professional experience
1999
1999
years of post-secondary education
Work History
Eligibility Specialist/Member Service Advocate
Conduent- Department of Medicaid Services
Valley, AL
09.2022 - Current
- Reviewed eligibility applications for Medicaid programs and ensured compliance with regulations.
- Conducted interviews to gather information for eligibility determination processes.
- Assist 50-100 members daily with benefit inquiries, claim resolution, and eligibility verification.
- Achieved and maintained 100% QA score for multiple consecutive months.
- Cross-trained to support providers, insurance agents, and case managers, reducing interdepartmental transfer time by 20%.
- Document all member correspondence in CRM ensuring HIPAA compliance.
- Educate members on plan benefits and care coordination, resulting in a 15% increase in first-call resolution.
- Provide step-by-step guidance for self-service portal use, reducing repeat inquiry calls by 12%.
Personal Care Assistant
Able Mabel Assisted Home Care
Westpoint, MI
08.2018 - 04.2022
- Delivered compassionate, personalized care, enhancing quality of life through daily living assistance.
- Maintained a safe and hygienic environment, contributing to zero safety incidents during tenure.
- Monitored and reported health condition changes to RNs, enabling timely interventions.
- Administered medications according to prescribed schedules and guidelines.
- Assisted with mobility and transportation needs for medical appointments or errands.
- Maintained accurate records of client care and observations in documentation systems.
- Built strong relationships with clients and families.
Teleconferencing Quality Assurance
West Corporation
West Point, GA
09.1999 - 03.2022
- Progressed from entry-level to management while gaining hands-on experience in multiple departments to optimize workflows and train employees.
- Monitored 50+ teleconference sessions weekly for quality, accuracy, and adherence to client standards.
- Utilized QA tools to complete evaluations.
- Oversaw scheduling, technical support, and post-session quality checks for client events.
- Developed account retention strategies that reduced churn in at-risk accounts.
- Led a team of Event Specialists, improving quality compliance.
Education
Diploma/Certification In Progress – Expected 2026) - Medical Billing And Coding
Penn Foster Career School
Valley , AL 08.2025 - 08.2025
Troup County Comprehensive High School
Lagrange, GASkills
- Member Advocacy
- Claims Processing
- Eligibility Verification
- Managed Care & Qualified Health Plans
- High-Volume Call Management
- De-escalation Techniques
- Live Chat Support
- Troubleshooting
- Client Retention
- CRM Software
- EHR/Data Entry
- Microsoft Office Suite
- Virtual Platforms
- HIPAA Compliance
- Quality Assurance Auditing
- Attention to Detail
- Verbal & Written Communication
- Team Leadership
- Active Listening
- Problem-Solving
Timeline
Diploma/Certification In Progress – Expected 2026) - Medical Billing And Coding
Penn Foster Career School
08.2025 - 08.2025
Eligibility Specialist/Member Service Advocate
Conduent- Department of Medicaid Services
09.2022 - Current
Personal Care Assistant
Able Mabel Assisted Home Care
08.2018 - 04.2022
Teleconferencing Quality Assurance
West Corporation
09.1999 - 03.2022
Troup County Comprehensive High School
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