SHAKESHA BOYD
Murfreesboro,TN
Summary
Reliable and high-performing leader, who quickly learns and master new concepts and skills, handles multiple responsibilities simultaneously while providing exceptional customer service. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level position. Ready to help team achieve company goals. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
13
13
years of professional experience
Work History
Human Resource Leave of absence Representative
CVS Health
02.2022 - Current
- Support service delivery model that reflects empathy and care for all colleagues and fosters an environment focused on the colleague experience
- Utilize myLeave system for new leave requests, extensions and responding to inquiries regarding an leave of absence
- Research questions utilizing knowledge base and other tools and resources to help provide guidance and support to the colleagues.
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Greeted customers warmly to set tone of customer experience and provide welcoming and friendly atmosphere.
- Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
- Learned and followed all organizational policies and procedures to maintain safe and professional working environments.
Senior Resolution Specialist (Work at Home)
CVS Health
11.2020 - Current
- Excellent managerial, leadership and organization skills, I proficiently adjusted customer account for efficient management, managed financial statement records, while investigated and resolved matters on rejected claims
- I assist members with their pharmacy benefit plans
- Taken inbound escalated calls and answer questions regarding prescription benefits, medication coverage, and mail order prescriptions so customers can understand their coverage and options
- Through skills and knowledge, I'm able to offer solutions that's needed to help simplify their health care experience
- Self-directed ability to problem solve in an positive, productive manner
- Comfortable relating to customers in an, helpful way that demonstrates genuine concern to improving the customer quality of life
- Reliability and compliance with scheduling standards
- Strong analytical skills with ability to evaluate, develop, and deliver alternative courses of action
- Ability to exhibit patience and empathy and express assurance and confidence
- Strong customer service skills, including courteous telephone etiquette and professionalism.
- Assisted management with keeping team working efficiently.
- Drove dispute resolutions using effective problem-solving and by guiding mutual understanding of opposing viewpoints.
- Monitored calls and proposed improvement plans for struggling representatives.
Patient Services Representative (Work at Home)
TriWest Healthcare Alliance
07.2019 - 10.2020
- Initiate calls to Veterans to educate them on their health care options and choices
- Reach out to health care professionals in the community to coordinate medical appointments and follow-up care needs for Veterans
- Provide customer service to Veterans and health care professionals through the course of their health care journey
- Follow processes of The Department of Veterans Affairs (VA) program and perform all tasks in a courteous and professional manner
- Protect health care privacy of patients by strictly following HIPAA regulations
- Research systems to find missing information; coordinate with other TriWest departments to resolve issues
- Work in a variety of technologies to perform required tasks
- Manage prioritized tasks in a time-sensitive environment
- Perform other tasks as assigned by leadership.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
PATIENT ACCESS REPRESENTATIVE II
EXPRESS SCRIPT
08.2015 - 07.2019
- Obtains required documentation, enter patient payment information including shipping, insurance plans, payer pricing and payer payment information accurately
- Provide patients with copayment, balance amounts, order status and offer copay assistance as needed
- Responsible for data entry, editing claims, and payment collections
- Review A/R aging reports and associated documents, contact delinquent accounts, resolve protocols and update report status for shipment
- Frequent follow up with payers and/or patients on outstanding account
- Possess complete understanding of the billing/collection process to resolve complex, outstanding claims and resolve the claim directly
- Verifies insurance and eligibility, patient demographics quickly and accurately, insert proper notation, and maintain spreadsheets
- Basic knowledge of medical billing terminology and payer codes
- Maintains a high level of confidentiality with employee, client information and follow HIPPA guidelines
- Serves as a patient advocate to assist patients in obtaining financial support
- Interacts with doctor offices concerning patients and their medicine
- Handled inbound telephone & written inquiries from pharmacists & doctors regarding prior authorization by screening, reviewing requests based on benefit plan design, client specifies and clinical expectations.
PATIENT ACCESS REPRESENTATIVE II
AEROTEK STAFFING/EXPRESS SCRIPT
12.2013 - 08.2015
- Obtained required documentation, enter patient payment information including shipping, insurance plans, payer pricing, and payer payment information accurately
- Provide patients with copayment, balance amounts, order status and offer copay assistance as needed
- Responsible for data entry, editing claims, and payment collections
- Review A/R aging reports and associated documents, contact delinquent accounts, resolve protocols and update report status for shipment
- Frequent follow up with payers and/or patients on outstanding account balance
- Possess complete understanding of the billing/collection process to resolve complex, outstanding claims and resolve the claim directly
- Verifies insurance and eligibility, patient demographics quickly and accurately, insert proper notation, and maintain spreadsheets
- Basic knowledge of medical billing terminology and payer codes
- Serves as a patient advocate to assist patients in obtaining financial support
- Interacts with doctor offices concerning patients and their medication
- Handled inbound telephone & written inquiries from pharmacists & doctors regarding prior authorization by screening, reviewing requests based on benefit plan design, client specifies and clinical expectations
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
PATIENT FINANCIAL COUNSELOR
BAPTIST MEDICAL GROUP
10.2010 - 12.2013
- Provide support to patients, and staff in coordinating patient pay billings, Medicaid, Medicare, Tricare applications and other patient financial issues that may arise
- Acts as a liaison between registration, Admissions, case management and patient accounts in resolving outstanding patients' accounts
- Contributes to the company completing the follow-up and collection from third party payers and self-pay accounts to enhance cash flow and obtain associated reimbursement based on established contracts
- Monitors collections and payments sent to the extended business office and bad debt
- Performs insurance verification process on all third-party payers and obtains initial and subsequent pre-authorization for services and surgeries
- Performs financial counseling processes on all patients prior to treatment, which includes patient financial obligations, billing practices and establishing payment arrangements
- Maintains A/R days against company guidelines for assigned carriers, appeal all claims, make timely inquiries with third party insurance companies on charges via telephone, on-line services, e-mail, etc
- Review all zero paid or incorrectly paid EOBs through resolution of account
- Gather materials for and apply to the insurance company for reconsideration/appeal of payment on claims, as needed
- Provide information on received payments as requested, including identification of overpayments and refunds
- Track carrier trends and report negative effects on payment trends in a timely manner
- Work closely with providers, auditor and leadership team to answer provider inquiries
- Provide excellent customer service to all internal and external patients.
Education
No Degree - Healthcare Administration
UNIVERSITY OF PHOENIX
Phoenix, AZ04.2016
Medical Office Professional - Medical Billing & Coding
REMINGTON COLLEGE
Memphis, TN02.2010
High School Diploma -
H.W. BYERS HIGH SCHOOL
Holly Springs, MS05.2003
Skills
- RFP
- Medical Billing
- Operations Improvement
- Administrative Operations
- Payment Tech Bill Payment System
- Integration payment and accounting systems
- Cixtrix
- Rumba
- Alstript
- Rxhomes
- Bluezone
- MS Office
- Product Development
- AS400
- PeopeSafe
- AS
- Technical Troubleshooting
Timeline
Human Resource Leave of absence Representative
CVS Health
02.2022 - Current
Senior Resolution Specialist (Work at Home)
CVS Health
11.2020 - Current
Patient Services Representative (Work at Home)
TriWest Healthcare Alliance
07.2019 - 10.2020
PATIENT ACCESS REPRESENTATIVE II
EXPRESS SCRIPT
08.2015 - 07.2019
PATIENT ACCESS REPRESENTATIVE II
AEROTEK STAFFING/EXPRESS SCRIPT
12.2013 - 08.2015
PATIENT FINANCIAL COUNSELOR
BAPTIST MEDICAL GROUP
10.2010 - 12.2013
No Degree - Healthcare Administration
UNIVERSITY OF PHOENIX
Medical Office Professional - Medical Billing & Coding
REMINGTON COLLEGE
High School Diploma -
H.W. BYERS HIGH SCHOOL
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