McKayla Sheppard
Taunton,MA
Summary
I am currently working as a Financial Clearance Specialist in a fast pace, high volume disproportionate hospital setting. I have previous history and extensive knowledge in customer service medical office administration, insurance verification and insurance authorizations. I have been previously acknowledged by leadership for constantly exceeding expectations in office management ability, customer service, organization and patient interactions.
Overview
18
18
years of professional experience
Work History
FINANCIAL CLEARANCE SPECIALIST LEAD
Signature Healthcare
10.2024 - Current
- In this role, I oversee the day-to-day operations of the department which include coaching staff and training, updating policies and procedures as warranted, handling complex patient issues, reviewing insurance denials and submitting notifications to hospital staff regarding potential patient care issues.
- Requested and Processed Insurance Referrals to expedite care
- Obtained timely prior authorizations for high tech imaging, spinal procedures, cardiac testing, surgeries, observation, and inpatient stays
- Verified timely completion of office tasks daily and weekly.
- Responsible for monitoring customer phone volume and to handle situations as needed.
- Established a strong organizational culture centered around teamwork, open communication channels, continuous learning opportunities for employees.
- Facilitated effective communication between departments to ensure smooth operations and seamless coordination of patient care efforts.
- Coordinated with other healthcare providers concerning treatment plans for patients.
- Communicated with doctors, nurses, patients and other employees to identify and resolve healthcare needs.
- Excellent communication skills, both verbal and written.
- Used critical thinking to break down problems, evaluate solutions, and make decisions.
- Mentored junior staff, fostering professional development and enhancing team capabilities.
- Coordinated patient referrals to specialized services, ensuring timely access to needed care.
- Assisted in scheduling patient appointments and coordinating referrals/resources when needed.
- Managed complex denial cases, ensuring thorough investigation and timely responses to payers.
- Improved communication between departments, expediting the resolution of denied claims.
- Identified root cause of denials to provide plans for denial resolution.
FINANCIAL CLEARANCE SPECIALIST
Signature Healthcare
10.2020 - 10.2024
- Ensured High Imaging Diagnostic tests approved before completion
- Scheduled patients and doctors for procedures as appropriate
- Constant Communication with team members, department leaders and physicians with issues and concerns.
- Acknowledged for being detail oriented and adaptable with new challenges and tasks.
- Trained new staff on prior authorization procedures, policies, and best practices to ensure consistency.
- Monitored and tracked authorization requests to maintain accurate records and follow up as necessary.
- Developed training materials for staff on updates in insurance policies and procedural changes.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.
- Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
- Facilitated cross-departmental training sessions to enhance understanding of prior authorization criteria and procedures.
- Improved patient satisfaction by efficiently managing prior authorization requests and ensuring timely approvals.
- Developed training materials for new hires on prior authorization systems, enhancing onboarding effectiveness and knowledge retention.
- Reduced errors in documentation by meticulously reviewing medical records and verifying patient information.
- Authorized surgical requests in accordance with applicable plan guidelines.
MEDICAL OFFICE COORDINATOR
Signature Healthcare
08.2017 - 10.2020
- I was tasked with establishing patient phone call and inquiry urgency while undertaking multiple tasks in the office. While ensuring patient satisfaction with the office process, we were able to implement new scheduling procedures and make continuity of care more proficient.
- Specialized in Safety Coaching & Compliance
- Exceeded expectations with work on Meditech, IDX and Kronos.
- Adapting to COVID-19 Changes to ensure practice operations continued.
- Worked on processed to make Continuity of Care more proficient.
- Developed training programs for new staff to enhance operational efficiency and service quality.
- Oversaw inventory management of medical supplies, ensuring timely availability and minimizing shortages.
- Facilitated communication between healthcare providers and patients to improve care coordination.
- Mentored junior coordinators on best practices in patient relations and administrative tasks.
- Maintained a high level of confidentiality by handling sensitive patient information with discretion and care.
- Provided exceptional customer service to patients, addressing concerns promptly and professionally.
- Addressed complaints made by patients and staff by escalating issues to supervision for further investigation.
- Reduced wait times for patients by implementing efficient check-in and check-out procedures.
- Proactively identified areas for improvement within the office workflow, implementing changes that led to increased productivity among staff members.
- Boosted morale among staff members by fostering a positive work environment through clear communication and support.
- Improved medical team collaboration by coordinating schedules, meetings, and conferences.
- Received, recorded and filed medical payments by check, cash, and credit card.
- Pulled charts and prepared for nurse and doctor assessment.
- Coordinated luncheons with Pharmaceutical Representatives.
- Reviewed and sent medical records to other physicians upon request.
- Maintained patient databases and updated information in alignment with HIPAA protocols.
- Aided with prescription refill requests.
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
- Monitored front areas so that questions could be promptly addressed.
Shift Supervisor
Hannaford Supermarket
10.2007 - 03.2018
- Implemented cash handling procedures to minimize discrepancies and losses.
- Trained new staff on register operations and customer service protocols.
- Developed strategies for reducing wait times during peak hours through effective queue management.
- Led team efforts in promoting store initiatives, driving increased sales performance.
- Greeted customers entering store and responded promptly to customer needs.
- Worked flexible schedule and extra shifts to meet business needs.
- Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
- Built relationships with customers to encourage repeat business.
- Maintained a balanced cash drawer, ensuring accurate accounting at the end of each shift.
- Helped customers complete purchases, locate items, and join reward programs.
- Restocked and organized merchandise in front lanes.
- Assisted customers with returns, refunds and resolving transaction issues.
- Counted money in cash drawers at beginning and end of shifts to maintain accuracy.
- Resolved customer complaints professionally, leading to improved customer relations and loyalty.
- Answered questions about store policies and addressed customer concerns.
- Contributed to store success by maintaining high standards of cleanliness throughout the facility.
- Adapted quickly to new technologies implemented at POS systems, ensuring seamless transition periods for both staff and customers.
- Provided backup support for other departments when needed, showcasing versatility within the retail environment.
- Learned duties for various positions and provided backup at key times.
- Reviewed financial transactions for compliance with company policies and regulatory standards.
- Maintained and processed invoices, deposits, and money logs.
- Reconciled and corrected issues with financial records.
- Posted daily receipts and payments in accordance with corporate protocols.
- Provided support during audits by supplying requested documentation promptly and accurately.
- Supported loss prevention efforts by conducting routine security checks, reporting suspicious activities, and deterring thefts.
- Removed trash, swept, and mopped floors for professional appearance.
- Rotated grocery products ensuring that expired or spoiled items were immediately removed and adhered to "first in, first out" rule.
- Collected shopping carts from parking lot and returned to stand to keep lot organized.
- Helped customers complete purchases by moving heavy items, collecting payments, and bagging purchases.
- Retrieved items for customers and verified prices.
Education
ASSOCIATE'S DEGREE - Science with a Medical Administration concentration
Bay State College
Boston, MA01.2016
Skills
- Service Leader
- Bookkeeping
- Triage & Organization
- Continuity of Care
- Patient Scheduling
- Meditech Knowledge
- Medical HIPAA Compliance
- Office Management
- Problem-solving
- Teamwork and collaboration
- Time management
- Multitasking
- Microsoft office
- Outlook
Timeline
FINANCIAL CLEARANCE SPECIALIST LEAD
Signature Healthcare
10.2024 - Current
FINANCIAL CLEARANCE SPECIALIST
Signature Healthcare
10.2020 - 10.2024
MEDICAL OFFICE COORDINATOR
Signature Healthcare
08.2017 - 10.2020
Shift Supervisor
Hannaford Supermarket
10.2007 - 03.2018
ASSOCIATE'S DEGREE - Science with a Medical Administration concentration
Bay State College