Sha’Nelle Wells

• Responsible for conducting complex business process analyses, needs assessments and cost/benefit analyses to align operations solutions with business initiatives
• Conducts quality reviews of completed work
• Ensure that all audits are completed, verified, and closed
• Performs analysis of audits to determine areas of training, development, and education
• Ensures that the quality work instructions/forms/documents are developed/revised as needed
• Generate and analyzes various provider reports to management
• Participates in testing system changes related to provider files.

• Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications
• Assist with process improvements related to Provider Enrollment
• Processes/enters/updates provider data information/applications into appropriate enrollment database used in evaluating/tracking the processing of the application and/or updating provider directories
• Effective customer service and organizational skills.

• Responsible for managing disability risk using tools such as medical/disability software: in dept review of medical records
• Accurate and timely administration of disability claims in accordance with philosophy, policy language, and state regulations and legal environment
• Frequent written and verbal communication with insured’s, medical providers, and employers
• Meet all departmental standards pertaining to production, quality, timeliness, and customer service
• Serve as a resource and/or mentor to VBS I’s.

• Responsible for adjudicating all claim levels by determining coverage eligibility, availability, selecting appropriate benefits, calculating payment, and determining disposition of claims
• Ensure accurate administration of each claim in accordance with the policy guidelines, and state regulations
• Ensure all Accident and Health claims are processed within expected time frames
• Communicate Accident and Health claim decisions and processes to internal/external customers in a clear and concise manner.

Relevant Coursework: ICD-10-CM/PCS Coding, CPT/HCPCS Coding, Medical Terminology/Anatomy, Pharmacology, Software Knowledge, 3M Coding & Reimbursement