Shalandra Cato
Columbia,SC
Summary
High performing Clinical Support Representative with over 5 years of connecting patients and healthcare providers to vital resources. Dedicated to executing on prescribed medical funding guidelines and policies. Maintains compassionate and sympathetic relations with consumers. Adept at balancing business interests with human-centric service models.
Overview
10
10
years of professional experience
Work History
Clinical Support Representative 3
Aetna, a CVS Health Company
05.2022 - Current
- Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet company set standards
- Assists with the completion of medical necessity documentation to expedite approvals and ensures that appropriate follow up is performed
- Collaborates with other departments to assist in obtaining prior authorizations/appeals
- Documents insurance company interactions and all prior authorization information in system
Patient Administration Specialist
U.S. Army Reserve
11.2013 - 11.2022
- Prepares health record copies and abstracts
- Prepares, files, safe- guards, transfers, and retires health records
- Maintains patient locator and suspense files
- Prepares, codes, and transmits clinical record cover sheets
- Transcribes daily information onto charts
- Transcribes physicians' orders, and prepares requests for diagnostic tests, consultations, and referrals
- Performs functions to admit, discharge, and transfer patients
- Verifies eligibility of care
- Prepares medical information for release.
Reimbursement Specialist
Talent Bridge
11.2021 - 05.2022
- Identified trends in reimbursement denials, recommending process improvements to minimize future occurrences.
- Ensured timely payment of claims by promptly addressing and resolving any discrepancies or issues with insurance providers.
- Supported company objectives by maintaining compliance with all relevant state and federal regulations governing medical billing practices.
- Contributed to increased team productivity by consistently meeting or exceeding individual processing goals.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
Customer Service Representative
Palmetto State Armory
04.2018 - 12.2019
- Answers inbound calls concerning orders, products, billing, claims, and escalate when appropriate
- Responsible for providing real time information regarding sales orders, repairs and returns for improving the overall experience provided to the customer
- Create shipping labels
- Provide 'One Call' resolution to customers' who have additional needs regarding their order, replacements or accessories
- Assist in processing and completion of returns, fix-its and/or repairs and provide data and analytics accordingly on an as needed basis
- Provide Administrative support when needed.
Entry Processor
DHL Global Forwarding
02.2017 - 03.2018
- Enter new customer orders into DHL computerized system using bills of lading; to obtain release of cargo
- Insert customer and account data by inputting text based and numerical information from source documents within time limits
- Completes document auto upload as needed into DHL computerized system
- Review data for deficiencies or errors, correct any incompatibilities if possible and check output
- Research and obtain further information for incomplete documents
- Generate reports, store completed work in designated locations and perform backup operations
- Scan documents and print files, when needed
- Respond to queries for information and access relevant files
- Comply with data integrity and security policies
- Ensure proper use of office equipment and address any malfunctions.
Education
Associate of Applied Science - Medical Billing And Coding
Horry-Georgetown Technical College
Conway, SC05.2024
Certificate - Patient Administration
Medical Education Training Campus
San Antonio, TX11.2021
High school diploma - General Studies
Lakewood High School
Sumter, SC06.2010
Skills
- Authorizations
- Performance metrics analysis
- Benefit Coverage
- HIPAA Compliance
- Insurance Verification
- Data entry proficiency
- Medical Coding
- Medical Terminology
- Clerical Support
- Records Management
- Digital filing
- Workflow Management
Accomplishments
Recognized for inspiring trust
Recognized for joining forces
Recognized for rising to the challenge
Recognized for high performance
Timeline
Clinical Support Representative 3
Aetna, a CVS Health Company
05.2022 - Current
Reimbursement Specialist
Talent Bridge
11.2021 - 05.2022
Customer Service Representative
Palmetto State Armory
04.2018 - 12.2019
Entry Processor
DHL Global Forwarding
02.2017 - 03.2018
Patient Administration Specialist
U.S. Army Reserve
11.2013 - 11.2022
Associate of Applied Science - Medical Billing And Coding
Horry-Georgetown Technical College
Certificate - Patient Administration
Medical Education Training Campus
High school diploma - General Studies
Lakewood High School
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