Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Shanell Wiley

Mequon,WI

Summary

Experienced Quality Auditor with strong analytical skills and a background in regulatory compliance and auditing. Over 8 years of experience in Auditing and Quality assurance, with a total of 16 years of expertise in the Health Care field. Recognized for a solution-focused approach and ability to collaborate with colleagues, management, and external clients. Dedicated to improving employee satisfaction and driving business success. Bringing a wealth of experience and knowledge to handle operational demands. Committed to delivering exceptional results as a hardworking team player.

Overview

26
26
years of professional experience

Work History

Credentialing Quality Auditor

Skygen USA
01.2014 - Current
  • Perform audits of staff work at appropriate intervals to ensure accuracy of work.
  • Complete delegated vendor audits by contacting vendors to gather and review necessary documents.
  • Assist in responding to client and state audits by gathering necessary documents.
  • Assist team members with complex and escalated provider questions and client issues.
  • Update manager on significant complaints and issues providing feedback on trends affecting the credentialing team for process improvement and resolution.
  • Act as a lesion between departments helping to maintain clear communications and timely problem resolutions pertaining to credentialing.
  • Facilitate Credentialing Committee Meetings by preparing agendas,maintaining detailed notes and sending out meeting minutes.
  • Assist with on board and new hire training and development documents within the department.
  • Enhanced department quality by conducting thorough audits and identifying areas for improvement.
  • Ensured timely completion of all assigned audits while maintaining a high level of detail and accuracy.

Provider/ Member Call Center Rep

Skygen USA
12.2012 - 01.2014
  • Answered physician offices questions regarding benefit covered services and procedures.
  • Identified and helped to resolve billing and claim discrepancies and rejections ensuring they were escalated to the appropriate department.
  • Managed high call volumes while providing exceptional customer support and maintaining professional composure.
  • Handled escalated calls professionally, effectively resolving complex issues and ensuring client satisfaction at all times.
  • Communicated member benefits, claims, eligibility and authorization status to members and physician offices.
  • Assisted with questions about plan enrollment and assigning primary care physicians, and updating third party payer information.
  • Mastered multiple software systems for seamless navigation during calls, improving efficiency and reducing hold times for customers.

Ambassador

Children’s Hospital of Wisconsin
01.2010 - 01.2012
  • Greeted patients and staff to create welcoming atmosphere.
  • Directed visitors within the hospital.
  • Transported patients within the hospital to various treatment areas
  • Responsible for moving and stocking wheelchairs throughout the hospital.


Distribution Rep

Children’s Hospital l of Wisconsin
01.2009 - 01.2010
  • I managed product request and billing inquires by phone, computer and fax
  • I also assisted with billing and product charges to patient rooms.
  • I distributed patient products and equipment within the hospital utilizing tug and the hospital tub system.
  • I was also responsible for updating financial information and properly documenting patient records using the electronic records system (Epic) to maintain accurate billing records.

Data Entry Clerk

C & E Transport
01.2005 - 01.2009
  • My Job duties were to manage and schedule patient’s appointments, and to process patient claims and Insurance payments.
  • Completed Medicare and Commercial payments through batching systems and other assigned pay procedures .
  • Completed office and clerical duties such as faxing, filling and data entry.
  • Enhanced data accuracy by meticulously reviewing and correcting errors in spreadsheets and databases.
  • Scanned documents and saved in database to keep records of essential organizational information.
  • Verified entered data against source documents to maintain consistency across multiple platforms within the organization.

Payment Processor

M & I Bank
01.1999 - 01.2005
  • My primary duties were to process checks and payments made on customer accounts
  • I also contacted customers with any billing discrepancies or item return courtesy calls
  • I was responsible for updating account payments to insure the correct accounts was credited and properly noted
  • I also manually signed and sorted checks and helped within my department to effectively meet and exceed our client needs and company goals.

Education

Milwaukee Bradley Tech High School

Healthcare Service Management -

Milwaukee Area Technical College
Milwaukee, WI
05.2026

Skills

  • Performance monitoring
  • Attention to Detail
  • Audit process management
  • Performance Improvement
  • Quality Management

Accomplishments

I filled in intermittently during my managers maternity leave taking over the leadership role in the department. During this time I acted as a resource for external clients and attended client meetings responding to client request in a timely manner. Represented the department as an expert in internal workflow discussions ran and completed client reports and tracked productivity.

Timeline

Credentialing Quality Auditor

Skygen USA
01.2014 - Current

Provider/ Member Call Center Rep

Skygen USA
12.2012 - 01.2014

Ambassador

Children’s Hospital of Wisconsin
01.2010 - 01.2012

Distribution Rep

Children’s Hospital l of Wisconsin
01.2009 - 01.2010

Data Entry Clerk

C & E Transport
01.2005 - 01.2009

Payment Processor

M & I Bank
01.1999 - 01.2005

Milwaukee Bradley Tech High School

Healthcare Service Management -

Milwaukee Area Technical College

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Shanell Wiley