Shamichael Manuel
Houston,TX
Summary
Detail-oriented healthcare professional with 9 years of experience in clinical operations, patient scheduling, and benefits administration. Expertise in managing electronic health records, conducting patient intake, and ensuring HIPAA compliance. Streamlined workflows and resolved complex patient issues while delivering high-quality service in fast-paced environments.
Overview
13
13
years of professional experience
Work History
Patient Service Representative
McKesson
01.2019 - 01.2026
- Schedule, reschedule, and cancel patient appointments via inbound and outbound calls.
- Coordinate appointments across multiple providers, specialties, and locations.
- Verify patient demographics and update information in the electronic health record (EHR).
- Confirmed insurance coverage and obtained necessary authorizations.
- Provide patients with appointment preparation instructions and required documentation details.
- Managed waitlists and optimized provider schedules, ensuring timely patient access to care.
- Document all interactions accurately in EHR systems.
- Ensure compliance with HIPAA and organizational policies.
- Handle high call volumes while maintaining professionalism and accuracy.
- Answer high-volume inbound calls from patients requesting medical assistance.
- Resolved scheduling conflicts and addressed patient concerns promptly to enhance patient satisfaction.
- Conduct structured intake and triage screening using approved protocols and scripting.
- Identify urgent or emergent symptoms and escalate calls to nurses or providers according to guidelines.
- Perform outbound outreach calls for appointment reminders, follow-ups, wellness checks, or care gap initiatives.
- Maintain HIPAA compliance and protect patient confidentiality at all times.
- De-escalated tense or emotional calls, maintaining professionalism and empathy to support patient needs.
- Coordinate with clinical teams to ensure timely care delivery.
- Meet productivity standards including call volume, average handle time (AHT), quality assurance scores, and first call resolution.
Health Benefits Specialist
Conduent
08.2016 - 01.2019
- Administer medical, dental, vision, life, disability, and supplemental insurance plans.
- Coordinated open enrollment processes and maintained documentation.
- Process new enrollments, changes, and terminations.
- Manage enrollment, changes, and terminations for employee benefit plans.
- Maintain accurate employee benefit records in HRIS systems.
- Explain plan coverage, deductibles, copays, coinsurance, and out-of-pocket maximums.
- Explain plan details, coverage options, premiums, deductibles, co-pays, and claims procedures.
- Provide guidance on eligibility requirements and qualifying life events.
- Verify eligibility for benefits and handle qualifying life events (QLEs).
- Guided employees in resolving claims questions and coverage disputes.
- Resolve claims issues, billing errors, and coverage disputes.
- Research and resolve claim denials or billing discrepancies.
- Educate employees on wellness programs and preventive benefits.
- Provide guidance on health and wellness programs.
- Serve as the primary liaison between employees and insurance carriers.
- Act as the primary contact with insurance carriers, brokers, and TPAs.
- Monitor vendor performance and compliance with service agreements.
- Compiled reports on enrollment, utilization, and costs to inform decision-making.
- Submit required documentation for prior authorizations.
- Ensure carriers provide accurate plan documentation and timely responses.
- Ensure carriers provide accurate plan documentation and timely responses.
Clinical Coordinator/Patient Access Service Representative
Sitel
07.2013 - 08.2016
- Facilitated patient intake, assessment, and follow-up care to enhance patient experience and outcomes.
- Acted as the primary point of contact for patients, addressing questions and concerns to improve patient satisfaction.
- Coordinated patient care activities and ensure efficient workflow across clinical departments.
- Collaborate with healthcare providers to develop care plans and ensure continuity of care.
- Managed referrals, diagnostic tests, and treatment processes across departments.
- Overseeing scheduling of clinical staff, including nurses, medical assistants, and support personnel.
- Supporting onboarding, training, and performance evaluation of clinical staff.
- Providing guidance on clinical procedures, protocols, and compliance standards.
- Ensuring adherence to policies, procedures, and quality standards.
- Fostering teamwork and professional development within the clinical team.
- Ensure compliance with HIPAA, OSHA, and other federal, state, and local regulations.
- Monitored clinical documentation and records for accuracy and completeness to ensure compliance and quality care.
- Engaged in quality improvement initiatives and patient safety programs.
- Maintain accurate patient records in electronic health record (EHR) systems.
- Generate reports on patient volume, outcomes, and clinical performance metrics.
- Communicated with insurance providers, billing staff, and external partners.
Education
High School Diploma -
Texas Success Academy
Arlington, TX10-2024
Skills
- Patient Scheduling & Appointment Coordination
- Patient Intake & Registration
- Appointment scheduling
- Medical Triage & Call Routing
- EHR management
- Medical documentation
- HIPAA Compliance & Confidentiality
- Telehealth & Virtual Patient Communication
- Healthcare compliance
- Patient eligibility verification
- Insurance verification
- Eligibility verification
- Claims processing
- Authorization management
- Benefits consultation
- Medicare
- Medicaid
- EOB analysis
- CPT and ICD-10 coding
- Medical billing
- Data Entry
- Inbound and outbound calls
- Email support services
- Customer support
- Healthcare compliance
- Patient confidentiality
- Healthcare compliance
Accomplishments
- Successfully managed 100+ patient calls per day, including triage and routing, while maintaining HIPAA compliance.
- Implemented follow-up and reminder protocols that increased patient attendance rates by 15%.
- Accurately verified insurance eligibility and collected co-pays, contributing to a 10% reduction in billing discrepancies.
- Assisted in onboarding and training new front desk staff, improving team efficiency and patient satisfaction scores.
- Coordinated multidisciplinary clinical teams, improving workflow efficiency and reducing patient wait times by 20%.
- Developed and maintained electronic health record (EHR) documentation standards, increasing data accuracy by 30%.
Timeline
Patient Service Representative
McKesson
01.2019 - 01.2026
Health Benefits Specialist
Conduent
08.2016 - 01.2019
Clinical Coordinator/Patient Access Service Representative
Sitel
07.2013 - 08.2016
High School Diploma -
Texas Success Academy