SHACOLE BENNETT
NJ
Summary
Self-motivated Provider Service Analyst brings proven leadership, organizational and customer relations skills. Independently solves problems and keeps teams on task to handle diverse business requirements. History retaining clients and talented staff.
Organized and efficient Provider Strategy Coordinator supporting corporate level officers and senior management personnel with demonstrated expertise in financial and operational leadership. Adroit professional exemplifies multidisciplinary managerial skill in process, procedure and policy improvement initiatives. Accomplished in workflow optimization techniques implementation which increase productivity, reduce labor and maintain business integrity and quality of service.
Overview
23
23
years of professional experience
Work History
Provider Strategy Coordinator
Horizon BCBSNJ
04.2024 - Current
- Managed project timelines for successful completion, ensuring milestones were met and deadlines were adhered to.
- Entered data, generated reports, and produced tracking documents.
- Improved team productivity with regular communication and progress updates, fostering a collaborative work environment.
- Enhanced operational workflows by maintaining well-organized documentation systems and updating records accurately as needed.
- Collaborated with department heads to develop strategic plans aligning with overall company objectives, fostering a unified approach toward shared goals.
- Coordinated cross-functional teams, resulting in seamless project execution and enhanced outcomes.
- Evaluated operational practices and identified improvement opportunities to develop revisions for systems and procedures.
- Implemented project management techniques to overcome obstacles and increase team productivity.
- Kept high average of performance evaluations.
HCBS Provider Advocate
United Health Care
04.2021 - 10.2023
- Provide New Provider Orientation with in one month new of received assignment
- Conduct provider educations daily, leaving room for open discussion annual for each provider
- Outreach the necessary team for assistance in rectifying providers issues
- Respond to matter with in 24 hours
- Work closely with the Clinical team, HCBS Solution team and HHA exchange to obtain resolution to authorization and claims matters
- Followed by providing detailed follow-up to the provider
- Review claims in Facets, to determine payment or denial status
- Review ICUE to confirm member details and authorization status
- Use NBD to obtain detailed information pertaining to the provider
- Access to the NJMMIS system to review members benefit status
- Run a monthly orbit report to submit to management, for review of my assigned providers activity
- Work diligently to obtain resolution to state inquiries regarding provider matters
- Create Impact cases or Case Exception to get provider claims updated and or correctly paid after full review
- Attend conference to network, provider guidance and information to providers
Provider Relation Assoc Analyst/ Assist to Supervisor/ Medical Cost Containment Coordinator
Care Allies (Cigna)
06.2012 - 12.2020
- Edit TruCare and ICMS Reports and enter the reports into SharePoint and assign work to coordinators
- Assist the supervisor running daily report, monitoring and handling emails and phone call from Providers
- Learn and train team members on new processes within the department
- Act as team support for additional questions and concerns
- Research provider and member information
- Assign claims for negotiation in Provider Link
- Verify authorization and negotiation information and create letters of negotiation in the TruCare and ICMS systems
- Prepare daily excel spreadsheet/reports for management and negotiators specifying quantity, location, client group and provider of a claim
- Audit completed claims in Uniflow and Meditrac
- Verify that the claim is paid correctly, add payment information and close
- Run a weekly Audit in Uniflow on paid, close claims
Accounting Clerk
Maxim HealthCare Temp (Horizon Blue Cross Blue Shield)
12.2011 - 04.2012
- Updating accounts receivable reports, such as unallocated funds reports, etc
- Updating clients account with address changes and etc
- Adding ACH to client accounts when requested
- Completed a high volume of data entry timely and accurate
- Worked out of an ECD database, solved issues on pending case
Account Service/ Billing Representative
Rutgers University
09.2010 - 04.2011
- Handled a high volume of calls daily for the Student Accounting Department
- Document all caller information and request on an excel spread sheet
- Instruct students and parents on ways to resolve billing issues
- Record and processed payments before forwarded to cashiering department
Billing Liaison/Trainer
LogistiCare
07.2009 - 09.2010
- Trained New Providers on the billing system
- Conducted daily Training classes for new employees
- Processed bills for Providers working with the state to provide transportation to members
Data Processing, Accounting Representative
New Jersey Carpenter Fund (NJCF)
04.2001 - 04.2009
- Reconciliation of a large check deposit servicing over one hundred clients daily, used for the daily breakdown
- Check accuracy of figures, calculations, and postings pertaining to business transaction
- Verified and entered new companies and members into database
Education
Psychology
Caldwell University
Caldwell, NJSkills
- Work Planning and Prioritization
- Relationship Building
- Project Coordination
- MS Office
- Discretion and Confidentiality
- Presenting Ideas and Plans
- Document Management
- Project Support
- Meeting Coordination
- Project assistance
- Schedule Management
- Administrative Leadership
- Database Management
- Regulatory Compliance
- Operations Management
- Point of Contact
- Staff Supervision
- Best Practices Implementation
- Medical Terminology
- Data retrieval systems
- Insurance Verification
- Contract Negotiation
- Multitasking and Organization
- Microsoft Office
- Documentation and Recordkeeping
- Phone and Email Etiquette
- Decision-Making
- Coaching and Mentoring
- Documentation and control
- Workflow Optimization
- Support Services
- Policy and procedure modification
- Cross-Functional Collaboration
Timeline
Provider Strategy Coordinator
Horizon BCBSNJ
04.2024 - Current
HCBS Provider Advocate
United Health Care
04.2021 - 10.2023
Provider Relation Assoc Analyst/ Assist to Supervisor/ Medical Cost Containment Coordinator
Care Allies (Cigna)
06.2012 - 12.2020
Accounting Clerk
Maxim HealthCare Temp (Horizon Blue Cross Blue Shield)
12.2011 - 04.2012
Account Service/ Billing Representative
Rutgers University
09.2010 - 04.2011
Billing Liaison/Trainer
LogistiCare
07.2009 - 09.2010
Data Processing, Accounting Representative
New Jersey Carpenter Fund (NJCF)
04.2001 - 04.2009
Psychology
Caldwell University
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