Overview
Work History
Timeline
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SHEILLA RUFFIN

PLANO,US

Overview

4
4
years of professional experience

Work History

Claims Resolution Specialist

Caremetx
03.2024 - 12.2024
  • Verified benefits accuracy, resolved discrepancies, enhanced client satisfaction
  • Streamlined missing information processes, improved verification efficiency
  • Collaborated with teams to ensure compliance, reduced processing errors
  • Analyzed data to identify trends, supported strategic decision-making
  • Facilitated communication between stakeholders, strengthened relationships
  • Managed multiple verification cases simultaneously while maintaining strict confidentiality and adhering to HIPAA guidelines
  • Optimized information retrieval workflows by implementing structured documentation methods, leading to substantial efficiency gains in case resolution
  • Conducted audits on claims files ensuring data accuracy and compliance
  • Processed and approved payments promptly, enhancing workflow efficiency
  • Collaborated with underwriters to resolve complex claim issues
  • Analyzed claim documents for accuracy, improving data integrity
  • Investigated customer inquiries, enhancing satisfaction and trust
  • Streamlined claims processing workflow by implementing systematic quality checks and maintaining strict compliance with industry regulations
  • Optimized customer communication channels for claims status updates, reducing response time and enhancing service delivery
  • Resolved complex customer inquiries through thorough investigation and clear communication of claims status and requirements
  • Partnered with cross-functional teams to resolve complex claims issues, establishing efficient communication channels and improving response times
  • Strengthened customer relationships through proactive communication and thorough resolution of complex claims inquiries

Claims Resolution Specialist

AllState
03.2024 - 12.2024

Healthcare Customer Service Representative

McKesson
12.2022 - 03.2024
  • Coordinated new intake documentation, HIPAA-mandated releases and other patient and office forms
  • Navigated multiple computer systems and utilized search tools to find information
  • Set up customer accounts in system and updated details to reflect current information
  • Examined policy coverage forms and other records to determine insurance coverage
  • Verified and obtained required referral, authorization, or pre-certification prior to services being provided
  • Helped new hires assimilate into workforce and get up to speed on procedures with successful onboarding processes
  • Helped managers enforce procedures and protocols with effective training strategies
  • Completed high volume of inbound and outbound calls within deadlines
  • Analyzed call volume and average call time to monitor performance and productivity

Lead Medical Assistant

Patriot Urgent Care
Germantown, MD
01.2022 - 12.2022
  • Updated records in EHR system, carefully protecting patient information and verifying data
  • Assisted clinicians with in-office procedures
  • Certified recipients to continue receiving benefits based on routine interviews
  • Scheduled benefits claimants for adjudication interviews to address questions of eligibility
  • Relieved burden on providers by delivering basic clinical care and educating patients on long-term care needs

Front and Back Office Lead Medical Assistant

Capital Heart And Wellness
Chevy Chase, MD
09.2020 - 12.2021
  • Supported medical staff by answering phones and preparing supply orders
  • Updated records in EHR system, carefully protecting patient information and verifying data
  • Applied knowledge of sterile techniques and OSHA regulations, optimizing health and safety
  • Helped physicians examine and treat patients by handing instruments, giving injections and removing sutures
  • Guided clients through claims procedures and resolved minor complaints during claims-handling process
  • Interacted extensively with various parties involved in claim process
  • Streamlined medical office operations by implementing dual-role management of front-desk patient coordination and back-office clinical procedures while maintaining HIPAA compliance

Timeline

Claims Resolution Specialist

Caremetx
03.2024 - 12.2024

Claims Resolution Specialist

AllState
03.2024 - 12.2024

Healthcare Customer Service Representative

McKesson
12.2022 - 03.2024

Lead Medical Assistant

Patriot Urgent Care
01.2022 - 12.2022

Front and Back Office Lead Medical Assistant

Capital Heart And Wellness
09.2020 - 12.2021

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SHEILLA RUFFIN