Shanelle Weeks
Bedford,OH
Summary
Proven leader with over ten years experience in the health care industry. Focused and driven to provide exceptional patient care and lead a professional team by working together to accomplish goals. Excellent customer relations aptitude and relationship-building skills. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance.
Overview
13
13
years of professional experience
Work History
Customer Service Representative RCM
CLEVELAND CLINIC FOUNDATION
01.2016 - Current
- Project Management Team
- Completes all customer service and work leaders requests depending on code submitted.
- Proficient in navigating through Epic system. Training new hires on company polices, procedures and best practices changes after Epic upgrades.on company policies, procedures, and best practices.
- Responsible for accurately adding and billing insurance, completing coding reviews or coding changes, rebill claims to insurance companies, call insurance to verify benefits, patient responsibilities, denials, claims status, and verification. Worked directly
- Completed all guarantor and demographic updates under registration in EPIC
- Determine refund request for patients or insurance companies
- Analyzed departmental documents and resolved escalated complaints and discrepancies from incoming patient correspondences regarding bills, financial assistance applications, and payment plans.
- Handled and worked all Epic Work Queues resolving itemized statement request for patients and attorneys, prior authorizations, payment collections and setting up payment plans, explained estimates for upcoming appointments and surgeries, payment transfers, medical record reviews and mailed correspondences as needed.
- Understanding of hospital UB04 claims and HC1500 professional physician claims, explained to patients their EOB- explanation of benefits.
- Provide excellent communication skills, both verbal and written to patients and coworkers.
- Uses EPIC Revenue cycle knowledge to identify and resolve issues related to registration, financial clearance, insurance company authorization requirements, billing, insurance company explanation of benefits, provider based billing, governmental requirements, following HIPPA rules and regulations. HCAP/FAP polices and restrictions, MyAccount, coding and collections.
- Strong knowledge of Medicare guidelines completing MSPQ for patients.
- Multi-tasks with multiple computer systems to communicate with patients and investigate, resolve and document patient inquires.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
- Enhanced patient satisfaction by promptly addressing concerns and providing accurate information.
- Increased efficiency and team productivity by promoting operational best practices.
- Handled escalated calls efficiently, finding satisfactory resolutions for both patients and the Cleveland Clinic Foundation.
- Investigated and resolved customer inquiries and complaints quickly.
- Increased efficiency and performance by monitoring team member productivity and providing feedback
- Boosted team morale by consistently recognizing colleagues' contributions and achievements.
- Analyzed customer service metrics to identify trends and develop strategies for improvement.
- Maintained detailed records of customer interactions and transactions, ensuring accurate documentation and follow-up.
- Resolved escalated customer issues, restoring confidence in company's commitment to service excellence.
- Trained new Customer Service Representatives on company policies, procedures, and best practices.
- Led monthly team meetings reviewing performance and set goals for continuous improvement.
- Participated in training programs to enhance product knowledge and customer service skills. Also in cross-functional teams to discuss ways to improve overall patient satisfaction across the company.
- Self-motivated, with a strong sense of personal responsibility.
- Skilled at working independently and collaboratively in a team environment.
- Demonstrated leadership, respect, friendliness and willingness to help wherever needed.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Demonstrated strong organizational and time management skills while managing multiple projects.
Workers Compensation Claims Representative
AmTrust Financial
01.2015 - 12.2015
- Followed up with the insured individuals regarding premium and deductibles payments.
- Answered customer questions regarding deductibles and premiums.
- Spoke with medical providers regarding claims and approvals for treatment for injured workers.
- Trained other claims staff members on proper handling and evaluation of injury claims.
- Checked claim status and issued checks for medical bills.
- Handled disability claims and completed audits.
- Explained insured their policy information amount breakdown
- Spoke to agents and clients regarding quotes and policy rules and procedures
- Researched claims and incident information to deliver solutions and resolve problems.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Documented information gathered in field and uploaded data to company database.
- Followed up with insured individuals regarding premium and deductibles payments.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Developed and maintained courteous and effective working relationships.
Memeber Care/Customer Service
CVS Health
04.2012 - 10.2014
- Placed and processed orders for medication shipment
- Member care leader and training all staff members
- Resolved rejected claims
- Understanding quantity limits allowed for medications under plan regulations, step therapy, and prior authorizations.
- Completed full prior authorization forms with medically trained individuals. Inputting medical diagnosis codes for patients to receive medication approvals
- Some understanding of medication uses and instructions
- Enrolled individuals in Medicare Part D plan new to Medicare 65+ and individuals under 65 with certain disabilities.
- Assisting pharmacist/techs, doctors, PA, MA, social workers and nursing homes.
- Pharmacy support. Providing pharmacy with patients benefits and copay structure.
- Some understanding of pharmacy policies and how medications are dispense and packaged.
- Assisted in training new serving staff members, improving overall team performance and cohesiveness.
- Addressed customer complaints or concerns professionally, ensuring swift resolution and maintaining positive relationships.
Education
High School Diploma -
Twinsburg High School
Twinsburg, OH2008
Skills
- Detailed-oriented and organized, with good analytical skills and problem solving ability
- Excellent navigating through EPIC and various systems
- Team leadership and Trainer
- Project management
- Ability to function independently and as a team player in a fast-paced environment
- Strong telephone, interpersonal, written and verbal communication skills
- Empathy and Engagement with Customers and Patients
- Proficient computer skills, Microsoft, PowerPoint, Excel and 40wpm
- Critical Thinking with De-Escalation Techniques
- Problem Resolution and Data Enrty
- Conflict Resolution and Follow-up skills
- Money handling abilities and payment processing
- Microsoft Excel and Microsoft Outlook
- Professional telephone demeanor
- Appointment Scheduling
- Team Development
- Administrative Support and Documentation
- Coordination and Research Skills
- Account Management Spreadsheets
- Staff education and training
- Medical terminology knowledge
Timeline
Customer Service Representative RCM
CLEVELAND CLINIC FOUNDATION
01.2016 - Current
Workers Compensation Claims Representative
AmTrust Financial
01.2015 - 12.2015
Memeber Care/Customer Service
CVS Health
04.2012 - 10.2014
High School Diploma -
Twinsburg High School