Microsoft Office Applications
Shala Maria Lokeni
Kapolei,HI
Summary
Experienced Office Management and Administration Professional experienced optimizing productivity, efficiency and service quality across various environments. Highly dependable, ethical and reliable support specialist and leader that blends advanced organizational, technical and business acumen. Works effectively with cross-functional teams in ensuring operational and service excellence.
Overview
17
17
years of professional experience
2
2
years of post-secondary education
Work History
Provider Practice Coordinator
Ohana Health Plan Subsidiary Of Centene Corp
Kapolei, HI
08.2019 - 09.2022
- Developed policies and procedures for effective practice management.
- Addressed and remedied all patient or team member issues.
- Developed and maintained electronic record management systems to analyze and process data.
- Communicated closely with patients, ensuring medical information was kept private.
- Provided outstanding support to entire staff which helped improve process flow and boosted efficiency.
- Assisted with regulatory issues such as compliance.
- Consulted with healthcare professionals on business decisions.
- Discussed medical histories with patients in effort to provide most effective medical advice.
- Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
- Created customized care plans, working with hospital staff and families to assess and meet individual needs.
- Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.
HEDIS Project Coordinator
Aerotek Staffing
Kapolei, HI
04.2019 - 08.2019
- Tracked hours and expenses to keep project on task and within budgetary parameters.
- Supervised multiple projects from project start through delivery by prioritizing needs and delegating assignments.
- Coordinated presentations for customers and project members to detail project scope, progress and results.
- Created job files for each project and maintained current data in each file.
- Liaised between departments to facilitate communication and keep appropriate parties updated on project developments.
- Kept projects on schedule by managing deadlines and adjusting workflows.
- Maintained database and spreadsheets with accurate inventory and status.
Authorization Clerk
CARE Hawaii - Community Based Case Management Dept
Honolulu, HI
05.2017 - 10.2018
- Submitted for prior authorization with required documentation to appropriate funding source.
- Resolved conflicts and negotiated mutually beneficial agreements between parties.
- Prepared variety of different written communications, reports and documents.
- Communicated with executives about consistent customer issues.
- Maintained files and controlled records to show correspondence activities.
- Reviewed documentation for accuracy and assessment of necessity.
- Reviewed authorizations from payer to determine approved or denied items.
- Gathered records pertinent to specific problems, reviewed for completeness and accuracy and attached records to correspondence as necessary.
- Completed form letters in response to requests or problems identified by correspondence.
HR/Compliance Administrative Assistant
CARE Hawaii Inc
Honolulu, HI
11.2016 - 05.2017
- Assisted managers and crew members with purchasing and corporate expense processing.
- Offered reception support, answered phones and greeted visitors.
- Supported general business operations by providing various administrative support activities as generalist.
- Scheduled conference rooms and assisted with setup.
- Maintained company manuals, resources, client data, training records and other items.
- Interacted with vendors to purchase and set up equipment and services.
- Managed phone and email correspondence and handled incoming and outgoing mail and faxes.
- Established administrative work procedures to track staff's daily tasks.
- Supported company leaders by managing budgets, scheduling appointments and organizing itinerary.
- Opened and properly distributed incoming mail to promote quicker response to client inquiries.
- Facilitated timely delivery of special projects to meet organizational and departmental objectives.
- Assisted coworkers and staff members with special tasks on daily basis.
- Organized logistics and materials for each meeting, arranged spaces and took detailed notes for later dissemination to key stakeholders.
- Managed filing system, entered data and completed other clerical tasks.
- Completed forms, reports, logs and records to quickly handle all documentation for human resources.
- Answered and managed incoming and outgoing calls while recording accurate messages for distribution to office staff.
- Managed paper and electronic filing systems by routing various documents, taking messages and managing incoming and outgoing mail.
- Transcribed and organized information to assist in preparing speeches and presentations.
Insurance Verification Specialist
The Queens Medical Center
Honolulu , HI
09.2013 - 11.2015
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Determined appropriateness of payers to protect organization and minimize risk.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Communicated verification and authorization status updates with various case management departments to facilitate decision-making for patient admissions and insurance coverage.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Observed strict procedures to protect sensitive patient information, medical records and payment data.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
Adjustment Examiner 2
HMSA, Hawaii Medical Service Association
Honolulu, HI
05.2006 - 09.2010
- Sifted and sorted through evidence and recorded findings.
- Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
- Conducted research, gathered information from multiple sources and presented results.
- Learned new skills and applied to daily tasks to improve efficiency and productivity.
- Developed and implemented performance improvement strategies and plans to promote continuous improvement.
- Improved operations through consistent hard work and dedication.
- Handled all appeal and special handling medical claims for manual processing
Customer Service Representative Specialist
HMSA, Hawaii Medical Service Association
Honolulu, HI
11.2004 - 05.2006
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Provided primary customer support to internal and external customers.
- Collected and analyzed customer information to prepare product or service reports.
- Recommended products to customers, thoroughly explaining details.
- Clarified customer issues and determined root cause of problems to resolve product or service complaints.
- Investigated and resolved accounting, service and delivery concerns.
- Responded proactively and positively to rapid change.
- Managed timely and effective replacement of damaged or missing products.
- Met customer call guidelines for service levels, handle time and productivity.
Certification Assistant 1
HMSA, Hawaii Medical Service Association
Honolulu , HI
11.2000 - 11.2004
- Issued checklists for team and worked collaboratively to resolve issues.
- Helped develop and manage digital records for certification documents.
- Maintained databases and entered information, offering available data to appropriate parties.
- Navigated documentation to identify qualifications.
- Compiled data from various sources to prepare certifications.
- Communicated with internal and external individuals to acquire information concerning certifications.
- Answered and managed incoming and outgoing calls while recording accurate messages for distribution to office staff.
- Followed detailed directions from management to complete daily paperwork and computer data entry.
- Completed daily logs for management review.
Education
Associate of Applied Science - Medical Office Management
Heald College
Honolulu, HI 10.2008 - 10.2010
Skills
Referral management
undefinedSoftware
Experienced in Epic & Elation EMR Systems
Typing Skills of 58 wpm
Timeline
Provider Practice Coordinator
Ohana Health Plan Subsidiary Of Centene Corp
08.2019 - 09.2022
HEDIS Project Coordinator
Aerotek Staffing
04.2019 - 08.2019
Authorization Clerk
CARE Hawaii - Community Based Case Management Dept
05.2017 - 10.2018
HR/Compliance Administrative Assistant
CARE Hawaii Inc
11.2016 - 05.2017
Insurance Verification Specialist
The Queens Medical Center
09.2013 - 11.2015
Associate of Applied Science - Medical Office Management
Heald College
10.2008 - 10.2010
Adjustment Examiner 2
HMSA, Hawaii Medical Service Association
05.2006 - 09.2010
Customer Service Representative Specialist
HMSA, Hawaii Medical Service Association
11.2004 - 05.2006
Certification Assistant 1
HMSA, Hawaii Medical Service Association
11.2000 - 11.2004
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