Shalonda Spears
Benton,AR
Summary
Dedicated and detail-oriented professional with extensive experience in customer service, insurance, and medical billing. Adept at handling complex inquiries, verifying insurance applications, and providing top-tier client support. Strong ability to manage multiple responsibilities, ensure compliance with regulations, and enhance operational efficiency. Seeking a position that leverages my skills in customer relations, insurance, and administrative support for career growth and development.
Overview
25
25
years of professional experience
Work History
New Patient Intake Representative
CCS Medical
Dallas, TX
06.2023 - Current
- Obtain and process authorizations for reorders
- Resolve patient issues and ensure accurate reorder processing via phone, document processing, and medical record validation
- Ensure patients have all required medical documentation to permit billing of services as assigned
- Maximize patient base through retention efforts and cross-selling via phone
- Audit configuration of supplies based on supporting documentation, formulary requirements, and manufacturer capabilities
- Maintain a strong understanding of medical documentation, insurance requirements, and company procedures
- Maintain a high degree of confidentiality due to access to sensitive information
- Ensure regular, predictable, and consistent attendance while being flexible to meet department needs
Member Care Representative
Tranzact Insurance LLC
Richardson, TX
02.2022 - Current
- Verify Medicare Advantage applications for accuracy and compliance
- Review enrollments and explain plan benefits to members
- Assist with various projects as assigned
- Conduct inbound/outbound insurance sales
- Enroll beneficiaries into Medicare Advantage plans
- Clearly explain Summary of Benefits and Evidence of Coverage to clients
Bill Review Analyst II
Avidel Med Management
Irving, TX
09.2018 - 11.2019
- Conducted medical bill reviews for Texas workers' compensation claims
- Provided inbound customer service solutions
- Applied Texas state fee schedule guidelines and regulations
- Researched reconsiderations and medical disputes per industry standards
- Assisted coworkers with daily reviews and compliance procedures
Substitute Teacher
HeadStart of Greater Dallas
Dallas, TX
08.2017 - 09.2018
- Supported early childhood development in a structured classroom environment
- Created a fun and safe learning atmosphere
- Followed teacher lesson plans to ensure continuity of education
- Engaged with infants and toddlers to foster developmental milestones
Site Coordinator
AmeriCorps Reading Partners
Dallas, TX
08.2016 - 06.2017
- Managed student enrollment and referrals for literacy programs
- Provided one-on-one tutoring to underperforming students
- Coached and supported community partners in program implementation
- Developed individualized reading plans to improve student literacy
Customer Service Specialist
Randstad Holdings
Dallas, TX
06.2015 - 08.2016
- Assisted guests with restaurant complaints and inquiries
- Provided customer support via phone and email communications
- Researched check details to verify accuracy
- Identified error trends to improve quality assurance processes
Customer Service Associate
AETNA
Irving, TX
09.2000 - 06.2014
- Assisted Nurse Case Managers in coordinating case management for injured workers
- Communicated with providers and employers regarding medical treatments
- Documented case management activities and outcomes
- Assigned referrals from third-party administrators to Nurse Case Managers
- Maintained daily referral logs for compliance tracking
- Performed quality reviews of processed medical bills
- Resolved disputes and ensured accuracy in billing operations
- Updated and revised client policies and procedures
- Reported error trends to management to improve workflow
- Reviewed claims for payment recommendations
- Ensured adherence to state fee schedule guidelines and industry regulations
- Communicated with medical providers to obtain necessary information
- Accurately processed line-item payment postings
- Handled insurance denials and generated follow-ups
- Balanced deposits and payments while managing reimbursement overpayments
Education
Yoga Fitness Certificate -
Blue Yoga Fitness
01.2020
High School Diploma -
Woodrow Wilson High School
01.1999
Skills
Customer Service and Client Relations
Insurance & Medical Billing
Administrative Support
Compliance & Regulatory Knowledge
Problem Solving & Dispute Resolution
Sales & Retention
Team Collaboration & Leadership
Educational Support & Tutoring
Organizational Skills
Yoga Fitness Knowledge
Timeline
New Patient Intake Representative
CCS Medical
06.2023 - Current
Member Care Representative
Tranzact Insurance LLC
02.2022 - Current
Bill Review Analyst II
Avidel Med Management
09.2018 - 11.2019
Substitute Teacher
HeadStart of Greater Dallas
08.2017 - 09.2018
Site Coordinator
AmeriCorps Reading Partners
08.2016 - 06.2017
Customer Service Specialist
Randstad Holdings
06.2015 - 08.2016
Customer Service Associate
AETNA
09.2000 - 06.2014
Yoga Fitness Certificate -
Blue Yoga Fitness
High School Diploma -
Woodrow Wilson High School
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