Shadiamond Wilson
Care Team Leader
Clanton,AL
Summary
Passionate healthcare professional with over a decade of experience in claims resolution and patient billing. Dedicated to making a positive impact through efficient and compassionate service. Demonstrating strong problem-solving skills, a love for collaboration, and the ability to simplify complex processes. Excels in dynamic environments. Expertise, warmth, and attention to detail ready to be utilized to ensure exceptional client experiences.
Overview
2025
2025
years of professional experience
Work History
Dispute Reviewer
C2C Innovations
8 2024 - Current
- Resolve complex disputes via CMS Portal, boosting accuracy and processing efficiency.
- Reduced turnaround time for reviews by effectively prioritizing tasks and managing deadlines.
- Acted as an advocate for clients when necessary, ensuring their needs were met and their voices heard throughout the case management process.
- Maintained strict confidentiality with sensitive client information, adhering to industry standards and company policies.
CLAIMS ANALYST
R1 Rcm
11.2021 - 08.2024
- Identified opportunities for cost savings by analyzing medical billing patterns across various departments.
- Submitted electronic/paper claims documentation for timely filing.
- Optimized workflow processes by identifying bottlenecks within the system, implementing necessary changes for increased efficiency.
- Skillfully navigated Medicare/Medicaid regulations in order to secure maximum reimbursement rates for qualifying services provided.
PROVIDER CLAIM RESOLUTION SPECIALIST
Blue Cross Blue Shield of Alabama
12.2018 - 10.2021
- Resolved billing disputes with insurers and providers, improving claim acceptance
- Analyzed denied claims to correct errors, enhancing first-pass acceptance by 25%
- Identified potential areas for improvement in the provider claim resolution process, leading to increased efficiency and reduced errors.
- Acted as a liaison between providers and other departments within the organization, fostering collaboration and coordination for better claim outcomes.
CUSTOMER SERVICE TEAM LEAD
Tmobile
11.2014 - 11.2018
- Led a team of 15 call center representatives, providing coaching and support to achieve a 95% customer satisfaction rating
- Implemented performance improvement strategies that increased team productivity by 20%
- Analyzed call metrics and quality reports to identify areas for development and optimize operational processes
- Resolved escalated customer issues, ensuring prompt and effective resolution to enhance customer experience
Education
High Diploma -
Huffman High School
Skills
Insurance collections
Patient Billing
MEDITECH EHR Software
Microsoft Excel
Claims Processing
Team Leadership
Conflict Resolution
Research proficiency
Websites
Timeline
CLAIMS ANALYST
R1 Rcm
11.2021 - 08.2024
PROVIDER CLAIM RESOLUTION SPECIALIST
Blue Cross Blue Shield of Alabama
12.2018 - 10.2021
CUSTOMER SERVICE TEAM LEAD
Tmobile
11.2014 - 11.2018
Dispute Reviewer
C2C Innovations
8 2024 - Current
High Diploma -
Huffman High School
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