Sha'Coby Youmans
Jacksonville,FL
Summary
Detail-oriented Medicare Specialist with proven skills in claims processing, regulatory compliance, and problem resolution. Committed to ensuring accuracy in claims and enhancing customer satisfaction.
Overview
1
1
Certification
3
3
years of professional experience
Work History
Medicare Specialist
UnitedHealth Care, (Foundever)
Jacksonville, FL
10.2025 - Current
- Verify member eligibility, benefits, and coverage.
- Review and process medical claims for accuracy and completeness.
- Analyze claims according to company policies and federal/state regulations.
- Investigated and resolved claim discrepancies and denials to ensure accurate and timely payments.
- Communicate with healthcare providers and members regarding claim status.
- Protect confidential patient information in compliance with HIPAA.
- Collaborated with internal departments to address and resolve complex claims issues, enhancing overall claims processing efficiency.
- Consulted with healthcare providers on questions related to billing codes and reimbursement rates associated with specific treatments covered by a patient's plan.
- Processed customer appeals for denied or reduced Medicare benefits.
- Ensured all documentation was completed correctly before submitting it for approval or payment processing according to established guidelines.
Compliance Analyst/Property Tax Specialist
Cotality ( Corelogic)
Irving, Texas
01.2024 - 10.2025
- Ensure compliance with federal, state, and company employment laws and regulations.
- Maintained employee personnel files and confidential HR records to ensure compliance with privacy regulations.
- Monitor HR policies, procedures, and compliance initiatives.
- Assist with internal and external audits.
- Process employee documentation, status changes, and benefits administration.
- Investigated employee concerns and facilitated resolutions to enhance workplace relations.
- Prepared HR reports and compliance documentation to support internal audits and regulatory requirements.
- Ensure compliance with Equal Employment Opportunity (EEO), FMLA, ADA, FLSA, and OSHA requirements.
- Collaborate with managers to improve HR processes and workforce compliance.
- Support performance management and training initiatives.
- Reviewed local, state, and federal regulations for compliance.
- Completed documentation for homestead tax exemptions accurately.
- Researched legal and appraisal topics by reviewing statutes, court decision and appraisal theory.
- Resolved account and statistical recordkeeping issues by preparing refunds for duplicate or excess tax payments, due notices and pending roll changes.
- Assisted with delinquent property tax sale by accepting payments and processing receipts to successful bidders.
Education
Associate of Arts -
University of Phoenix
05-2027
High School Diploma -
William M. Raines
Jacksonville, FL06-2000
Skills
- Claims processing
- Medicare Compliance
- Claims Review Process
- Claims Monitoring
- Claims Risk Assessment
- Claims Reporting
- Benefit Policy Management
- Regulatory compliance
- Healthcare industry experience
- Claims Governance
- Claims Quality Control
- Process Improvement
- Data analysis
- Documentation oversight
- Recordkeeping
- Data Privacy
- Confidential Information
- CITRIX and AWS knowledge
- Customer service
- Problem resolution
- Team collaboration
- Communication skills
- Recordkeeping
- Data Privacy
- Confidential Information
- Claims Review
Certification
- HIPAA Privacy and Security Certification
Medical Terminology Certificate
Healthcare Compliance Certificate
Fraud, Waste, and Abuse (FWA) Training
Medicare and Medicaid Compliance Training
Timeline
Medicare Specialist
UnitedHealth Care, (Foundever)
10.2025 - Current
Compliance Analyst/Property Tax Specialist
Cotality ( Corelogic)
01.2024 - 10.2025
Associate of Arts -
University of Phoenix
High School Diploma -
William M. Raines