LAURA SHELEBY
Downey,CA
Summary
Supportive Eligibility Specialist with extensive engagement, and dedicated service skills. Bilingual professional with the skill to maintain accurate eligibility records, handle multiple duties, successfully manage the intake enrollment process, successfully manage case documentation, and resolve complex inquiries, ensuring high levels of client satisfaction.
Overview
25
25
years of professional experience
Work History
Enrollment Specialist
Maravilla Foundation
Commerce, CA
10.2023 - Current
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Exceeded customer satisfaction by finding creative solutions to problems.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
- Updated databases with new and modified customer data.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
Eligibility Specialist
Long Beach Community Action Partnership
Long Beach, CA
04.2021 - 09.2023
- Reviewed referral sources for appropriateness prior to admission into program.
- Maintained accurate records of all client interactions according to agency policies and procedures.
- Verified insurance eligibility, benefits, and patient liabilities for defined services.
- Maintained accurate records and documented client data in company databases.
- Answered and logged incoming inquiries via phone, fax and email.
- Assisted with the preparation of reports and presentations on intake activities and client demographics.
- Connected individuals with relevant community resources and coordinated referrals.
- Maintained accurate and up-to-date records of client interactions and services provided.
Eligibility Verifier
Long Beach Memorial Medical Center
Long Beach, CA
11.2012 - 11.2019
- Developed and maintained professional relationships with insurance representatives.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Updated patient and insurance data and input changes into company computer system.
- Responded to patient inquiries regarding insurance coverage and billing issues.
- Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
- Managed multiple tasks and priorities in a high-volume, fast-paced environment.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
Eligibility Representative
Delta Dental of California
Cerritos, CA
08.2000 - 10.2010
- Processed paperwork related to benefit determinations within established timelines.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Contacted client references and employers to determine legitimacy of applicant information.
- Provided customer service support in a professional manner.
- Reviewed applications to verify client information and resolve discrepancies.
- Explained reasons behind application denials and recommended further action.
- Provided technical assistance on use of software programs used in enrollments.
- Reconciled discrepancies between internal systems and external databases.
Education
GED -
Lynwood Adult School
Lynwood 06-1991
Skills
- Customer service
- Data entry
- Insurance verification
- Database management
- Eligibility determination
- Problem solving
- Attention to detail
- Data entry skills
- Task prioritization
- Customer service background
Languages
Spanish
Professional
English
Professional
Timeline
Enrollment Specialist
Maravilla Foundation
10.2023 - Current
Eligibility Specialist
Long Beach Community Action Partnership
04.2021 - 09.2023
Eligibility Verifier
Long Beach Memorial Medical Center
11.2012 - 11.2019
Eligibility Representative
Delta Dental of California
08.2000 - 10.2010
GED -
Lynwood Adult School