SHANEYKA RODRIGUEZ
RUSKIN
Summary
Dedicated Behavioral Health Care Coordinator with over 8 years of healthcare experience specializing in behavioral health case management, care coordination, member advocacy, and provider collaboration. Experienced in conducting comprehensive assessments, developing care plans, coordinating community resources, and improving member outcomes. Recognized for strong organizational skills, attention to detail, and the ability to build collaborative relationships across multidisciplinary teams. Recently completed a Bachelor's degree in Human Services while maintaining consistent academic honors, demonstrating a strong commitment to professional growth and excellence.
Overview
19
19
years of professional experience
Work History
Behavioral Health Care Coordinator
Centene Corporation
Tampa, FL
02.2020 - Current
- Coordinate behavioral health services for members with complex mental health and substance use needs.
- Complete comprehensive assessments to identify members' medical, behavioral, and social service needs.
- Conduct telephonic outreach to members, caregivers, providers, and community agencies to coordinate treatment and remove barriers to care.
- Advocate for members by connecting them with behavioral health, medical, housing, transportation, financial, and other community support services.
- Educate members on available benefits, treatment options, community resources, and self-management strategies.
- Maintain accurate, timely documentation in compliance with company policies, HIPAA regulations, and NCQA/CMS standards.
- Trained and mentored junior staff on best practices in case management protocols.
Supervisor- Provider Specialist Team
Continental Benefits
05.2018 - 11.2019
- Entered, on average, 90-100 doctor and facility records in the system for claims processing.
- Updated provider and facility W9 & 1099 records.
- Added Network & Pricing for specific client contracts.
- Matched claim information to existing patient records whenever the system was unable to automatically find a match.
Claims Processing (APC Encoder)
Continental Benefits
03.2017 - 05.2018
- Priced claims using APC Encoder- External Application for claims pricing and processing.
- Responsible for accurately communicating claims payment information and/or denials to claims processors.
- Price an average of 50-65 claims per day.
- Provided leadership with a daily report of the days’ work meeting daily expectations.
Customer Service
Continental Benefits
04.2016 - 03.2017
- Took an average of 60-80 calls per day
- Kept detailed documentation of calls from patients and providers.
- Responsible for accurately explaining plan benefit details including coverage, deductibles and coinsurance to members and providers.
- Assisted with billing inquiries and explaining claims payments and accumulations to members.
Customer Service Representative
Spectrum
Riverview, FL
05.2015 - 01.2016
- Took an average of 60-80 inbound calls per day from customers in which I resolve, assist, and prove resolutions for service issues.
- Resolved customer inquiries through effective communication and problem-solving skills.
- Managed customer accounts, ensuring accurate information and timely updates.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Assisted with billing inquiries.
- Booking trouble calls for service issues with internet, tv and home phone.
APAC Customer Service- UPS Shipping
10.2011 - 07.2013
- Scheduling pick-ups and drop-offs for clients including Wal-Mart, Target, Overstock, Amazon.com etc...
- Kept organized documentation of customer complaints and compliments through email for driver dispatch.
- Trained new employees on multiple programs and data entry software.
- Take an average of 80-100 inbound calls per day from ups customers in which I resolve, assist, and prove resolutions for problems with packages or any customer service inquiry.
Credit Granting, Customer Service Specialist
Macys Credit Customer Service
St. Petersburg-Clearwater, FL
06.2010 - 10.2011
- Answered an average of 80-100 calls per day by addressing customer inquiries, solving problems and providing new product information.
- Contacted customer to follow up on purchases, suggest new merchandise and inform them about promotions and upcoming events.
- Asked open-ended questions to assess customer needs.
- Processed payments of large amounts due from clients and promptly contacted clients with past due payments.
HMS Host- Tampa Int'l Airport
Tampa, FL
10.2007 - 06.2010
- Greeted customers entering the store to ascertain what each customer wanted or needed.
- Described product to customers and accurately explained details and care of merchandise.
- Answered product questions with up-to-date knowledge of sales and store promotions.
- Conducted weekly walk-throughs with the manager to discuss interior or visual displays, including store window presentation.
Education
High School Diploma -
D. W. Waters High School
05-2007
Associate of Science - Criminal Justice
ITT Technical Institute
FL05-2009
Bachelor of Arts - Human Services
Southern New Hampshire University
New Hampshire, OH05-2026
Skills
- Bilingual (English, Spanish)
- Multicultural sensitivity
- Mental health assessment
- Professionalism
- Case management
- Outreach programs
- Exceptional communication skills
- MS Windows proficient
- Teamwork and collaboration
- Attention to detail
Timeline
Behavioral Health Care Coordinator
Centene Corporation
02.2020 - Current
Supervisor- Provider Specialist Team
Continental Benefits
05.2018 - 11.2019
Claims Processing (APC Encoder)
Continental Benefits
03.2017 - 05.2018
Customer Service
Continental Benefits
04.2016 - 03.2017
Customer Service Representative
Spectrum
05.2015 - 01.2016
APAC Customer Service- UPS Shipping
10.2011 - 07.2013
Credit Granting, Customer Service Specialist
Macys Credit Customer Service
06.2010 - 10.2011
HMS Host- Tampa Int'l Airport
10.2007 - 06.2010
High School Diploma -
D. W. Waters High School
Associate of Science - Criminal Justice
ITT Technical Institute
Bachelor of Arts - Human Services
Southern New Hampshire University