Open To Work
Monique Shepperson
Chester,VA
Summary
Senior claims analyst with proven ability to manage complex claims processes and grant applications. Expertise in policy language analysis enhances compliance and boosts efficiency in claims resolution. Strong communication skills facilitate stakeholder relationship building and alignment with organizational goals.
Overview
19
19
years of professional experience
Work History
Senior Grants Analyst
Accessia/PSI
Chesterfield, Virginia
01.2024 - Current
- Developed and managed grant applications, ensuring accuracy and compliance with applicable regulations.
- Managed grant application processes for diverse funding opportunities, enhancing alignment with organizational goals.
- Reviewed and analyzed grant proposals for compliance and alignment with guidelines.
- Coordinated grant reporting requirements, ensuring timely submissions to maintain funder compliance.
- Monitored budget expenditures related to awarded grants for accuracy.
- Communicated regularly with external funders regarding project status updates.
- Assisted in preparation of programmatic reports for funders and partners, highlighting project outcomes and impacts.
- Assisted in developing scopes of work, budgets, and other documents related to grant activities.
- Coordinated the review process of grant applications by internal stakeholders.
- Researched changes in government regulations related to grant administration processes.
- Participated in program evaluation activities as requested by senior management.
RETIREE HEALTH PLAN ADMINISTRATOR
Virginia Housing
Glen Allen, US
08.2020 - 02.2023
- Reviewed grant budgets and ensured compliance with regulations.
- Maintained comprehensive records of grants and funding activities to ensure accurate reporting and compliance.
- Assisted in preparing detailed reports for funders on project progress, highlighting key milestones and outcomes.
- Coordinated the preparation of budgets, narratives, tables, and timelines for grant applications.
- Maintained organized records of grant activities, including award letters, contracts, invoices, and expenditure documentation to support audits and funding accountability.
- Assisted with developing procedures for monitoring performance outcomes associated with grants-funded projects.
CARE COORDINATOR/ WORKER SUPERVISOR- NON-CLINICAL
Magellan Complete Care of Virginia
Glen Allen, US
07.2015 - 08.2020
- Coordinated care by managing the prior authorization process and liaising with healthcare providers to obtain necessary medical records, ensuring timely delivery of services.
- Oversee team performance and report to leadership, resolving client issues efficiently.
- Coordinated cross-functional efforts to resolve complex client issues, strengthening relationships and enhancing client satisfaction ratings.
- Managed an operational team dedicated to healthcare payer claims, ensuring adherence to processes and maintaining high service quality.
- Enhance staff development through strategic hiring and career planning initiatives.
- Developed targeted training and mentorship programs to foster staff development and cultivate a motivated team focused on performance excellence.
- Led a claims team to enhance compliance and quality, achieving measurable service improvements and increasing operational efficiency.
- Conduct audits to enhance coding accuracy, elevating documentation standards.
- Conducted detailed audits to improve coding accuracy, resulting in elevated documentation standards and reduced claim processing errors.
- Utilize analytics for trend analysis, boosting service delivery effectiveness.
- Utilized Tableau to analyze financial records, identifying trends that improved claims accuracy and streamlined processing.
- Streamlined retiree health benefits operations, enhancing service delivery speed and ensuring 100% compliance with policy guidelines.
- Communicated with retirees about claims status, providing clear instructions for required documentation to enhance their understanding of the process.
- Provided empathetic support to retirees navigating the claims process, enhancing their experience and building trust in the system.
- Maintained comprehensive records of reimbursement claims, verifying compliance with IRS standards to uphold financial integrity.
BILLING AND CLAIMS SUPERVISOR
Pediatrix
Glen Allen, US
08.2010 - 07.2018
- Managed the medical billing operations, ensuring compliance with third-party requirements and regulatory guidelines at federal, state, and local levels.
- Investigated electronic claims submission errors and collaborated with departments to resolve issues, ensuring timely claims processing.
- Utilized Tableau to generate daily and weekly reports, enhancing team coordination through Epic for claim status monitoring.
CLAIMS PROCESSOR/ PROVIDER AND MEMBER SERVICES QUALITY MANAGER
General Dynamics
Chester, US
08.2007 - 07.2010
- Reviewed and processed Medicare and Dual Enrollment claims, ensuring adherence to state Medicaid eligibility criteria and timely resolution of beneficiary inquiries.
- Evaluated Medicare claims for accuracy, ensuring expedited processing and compliance with state regulations, leading to fewer disputes and improved beneficiary satisfaction.
- Analyzed claim trends to identify recurring issues, implementing corrective measures that led to noticeable gains in approval rates.
- Streamlined claims processing workflows, achieving noticeable gains in efficiency and reducing resolution times for beneficiary inquiries.
- Streamlined the prior authorization process, significantly reducing delays and ensuring timely access to necessary medical services.
- Orchestrated care coordination efforts to ensure timely access to medical services, enhancing patient satisfaction and expediting treatment timelines.
- Analyzed utilization trends to improve case management workflows, leading to more efficient resource allocation and enhanced patient outcomes.
- Developed a tracking system for care transitions to facilitate member access to community resources and improve continuity of care.
- Maintained accurate documentation of member interactions and care plans, ensuring compliance with industry standards and enhancing service quality.
- Streamlined billing processes to enhance accuracy, resulting in a reduction of claim denials and improved revenue cycle efficiency.
- Streamlined billing processes, enhancing accuracy and reducing claim denials, which significantly improved revenue cycle efficiency.
- Maintained strict compliance with HIPAA regulations while communicating claim statuses and documentation requirements to providers and beneficiaries.
- Audited claims documentation to maintain HIPAA compliance and ensure confidentiality, which improved operational efficiency.
- Delivered constructive feedback to customer service representatives, enhancing overall performance and service quality in addressing beneficiary issues, including claims and enrollment processes.
- Implemented training programs for customer service teams, enhancing service quality and reducing resolution times for beneficiary inquiries.
- Developed training programs for staff on billing software, enhancing team proficiency and ensuring compliance with evolving regulations.
- Facilitated cross-departmental meetings to streamline communication between claims and customer service, fostering a unified approach to problem-solving and enhancing overall service delivery.
- Contributed to team development by mentoring new staff, leading training initiatives, and staying abreast of evolving industry information to maintain accuracy in member and provider interactions.
- Provided mentorship to team members, promoting a culture of continuous improvement and collaboration, which strengthened team dynamics and morale.
- Streamlined claims processing workflows, achieving noticeable gains in efficiency and reducing resolution times for beneficiary inquiries.
Education
BACHELOR'S DEGREE - HEALTH SCIENCES
South University
Richmond, VirginiaSkills
- Grant management and funding compliance
- Grant tracking software
- Policy interpretation
- Healthcare operations
- Data analysis and visualization
- Epic, CPT, and ICD-10 proficiency
- Project management
- Stakeholder engagement
- Time management
- Critical thinking and appeals
Work Preference
Job Search Status
Open to workLocation Preference
RemoteSalary Range
$55000/yr - $200000/yrTimeline
Senior Grants Analyst
Accessia/PSI
01.2024 - Current
RETIREE HEALTH PLAN ADMINISTRATOR
Virginia Housing
08.2020 - 02.2023
CARE COORDINATOR/ WORKER SUPERVISOR- NON-CLINICAL
Magellan Complete Care of Virginia
07.2015 - 08.2020
BILLING AND CLAIMS SUPERVISOR
Pediatrix
08.2010 - 07.2018
CLAIMS PROCESSOR/ PROVIDER AND MEMBER SERVICES QUALITY MANAGER
General Dynamics
08.2007 - 07.2010
BACHELOR'S DEGREE - HEALTH SCIENCES
South University