Summary
Overview
Work History
Education
Skills
Interests
Timeline
Teacher

Shameika Bastine

Katy,TX

Summary

Energetic healthcare information management professional with 14 years of experience while demonstrating leadership skills with well-versed knowledge of guidelines concerning medical claims. Adept at analyzing complicated insurance data working in conjunction with insurance representatives and monitoring payment progress. Detail-oriented, observant, and possess the ability to build great rapport internally and externally.

Passionate Teacher with experience developing and implementing diverse curriculums covering wide range of subjects. Highly skilled at motivating students through positive encouragement and reinforcement of concepts via interactive classroom instruction and observation. Successful in helping students develop strong literacy, numeracy, social, and learning skills.

Overview

23
23
years of professional experience
12
12
years of post-secondary education

Work History

Teacher

Holman St Baptist Church
Houston, TX
06.2015 - Current
  • Communicated frequently with parents, students and faculty to provide feedback and discuss instructional strategies.
  • Planned and implemented integrated lessons to meet religious and academic content.
  • Held conferences with parents to address questions, discuss academic progress and encourage learning goals.
  • Worked cooperatively with other teachers, administrators and parents to help students reach learning objectives.
  • Evaluated and revised lesson plans and course content to achieve student-centered learning.
  • Encouraged creative thinking and motivated students by addressing individual strengths and weaknesses based on each student learning abilities.

Provider Claims Analyst

CIGNA
Houston, TX
01.2019 - 04.2022
  • Review and process medical claims submitted by paper and electronically by providers for payment
  • Assist medical providers with medical claims status and patient eligibility/ benefits information
  • Manage client accounts and various queues reviewing independent claims to determine if requests are payable
  • Research systems and data base for historical performance and outcomes to provide analytics
  • Prepare written rationale of claim decision based on review of contractual provisions and plan specifications and analysis of medical records
  • Adheres to adjudication policies and procedures to ensure proper payment on claims
  • Audit randomly selected claims to ensure quality processing.
  • Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.

Senior Resolutions Representative

UNITED HEALTH GROUP
Houston, TX
01.2014 - 01.2019
  • Assisted with investigating, recovering, and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
  • Managed over 50 customer calls per day in addition to increasing productivity by 10%
  • Ensured adherence to state and federal compliance policies, reimbursement policies, and contract compliance
  • Determined problem areas to recommend revised policies and procedures for call center and monitor calls to determine customer service needs
  • Maintained tracking tool of recovery progress, preparing weekly and monthly reports for management
  • Performed special projects, reconciliations, research, and analysis which contributed to quality claims processing improvements
  • Eliminated claims overpayments by performing root cause analysis and proposed corrective actions.

Claims Analyst Lead

01.2008 - 01.2014
  • Performed claims quality assurance audits to measure accuracy and completeness of reported claims
  • Assisted management in evaluating department procedures and workflow regularly to identify opportunities for improvement
  • Ensured legal compliance by following guidelines, account contracts, and company's business plan
  • Analyzed high-level complex operative reports and medical records to abstract clinical data by assigning EOB’s, CPT, ICD-9/ICD-10, and HCPCS codes from patient records in accordance with coding classification systems
  • Identified trends and partnered with support team and management while making recommendation and improve operational performance.

Executive Assistant

01.2007 - 01.2008
  • Answered and screened 30+ calls daily while taking messages with high degree of accuracy
  • Managed executives’ itinerary such as appointments and streamlined scheduling procedures
  • Developed and updated spreadsheets databases to track & analyze report on performance sales data
  • Managed office inventory, incoming/ outgoing mail, technical support, and visitors
  • Maintained 100% confidentiality of all communications and documentation according to company policy
  • Updated spreadsheets and created presentations to support executives and boost team productivity
  • Screened calls and emails and responded accordingly to support executive correspondence
  • Used advanced software to prepare documents, reports and presentations
  • Facilitated training and onboarding for incoming office staff
  • Responded to emails and other correspondence to facilitate communication and enhance business processes

Education

BS - Health Administration

University of Phoenix
Tempe, AZ
09.2010 - Current

Skills

Time Managementundefined

Interests

Certifications in Teaching

Teaching ELA&Special Populations

Timeline

Provider Claims Analyst

CIGNA
01.2019 - 04.2022

Teacher

Holman St Baptist Church
06.2015 - Current

Senior Resolutions Representative

UNITED HEALTH GROUP
01.2014 - 01.2019

BS - Health Administration

University of Phoenix
09.2010 - Current

Claims Analyst Lead

01.2008 - 01.2014

Executive Assistant

01.2007 - 01.2008

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Shameika Bastine