Shanica Jeffries
Wake Forest
Summary
Adept at navigating the complexities of the healthcare industry, I excelled in insurance benefits verification and prior authorization processing during my time at Johnson & Johnson, Janssen Pharmaceuticals. With a proactive approach and strong communication skills, I played a key role in improving the timeliness and accuracy of claims processing, contributing to enhanced operational efficiency and ensuring smooth reimbursement workflows. My ability to collaborate across departments and address challenges head-on enabled the seamless processing of specialty medications and ensured high-quality support for both providers and patients.
Overview
10
10
years of professional experience
Work History
Reimbursement Specialist
Johnson & Johnson, Janssen Pharmaceuticals
Raleigh
03.2024 - Current
- Verified insurance coverage for a variety of pharmaceutical products, focusing on specialty medications and biologics, such as Simponi Aria, Remicade, Tremfya, and Stelara.
- Worked directly with insurance providers to ensure the timely and accurate processing of benefits verification and prior authorizations.
- Provided detailed follow-up on authorization statuses, addressing any roadblocks or delays, and working with the provider and payer to resolve issues.
- Maintained thorough records of insurance verification activities, including detailed reports and status updates for providers and internal teams.
- Assisted in the preparation of prior authorization and appeal documentation, ensuring full compliance with payer guidelines and regulatory requirements.
Account Receivable
Corrohealth
Raleigh
11.2022 - 07.2023
- Managed the billing and accounts receivable process for medical services, including dialysis treatments, ensuring timely and accurate submission of claims.
- Reviewed and resolved claim denials for various medical specialties, with a focus on dialysis services, ensuring appropriate adjustments were made when necessary.
- Submitted appeals with supporting documentation for denied claims, including medical necessity letters and proof of timely filing.
- Followed up on unpaid claims and worked with payers to ensure claims were reprocessed and paid accurately.
- Utilized billing software and payer portals to track claims, submit appeals, and monitor the status of claims in the reprocessing pipeline.
- Provided detailed reports and updates to management regarding accounts receivable aging, claim status, and any outstanding issues.
Customer Service Representative
BCBS NC
Durham
05.2019 - 08.2022
- Serve as the first point of contact for patients, addressing inquiries related to insurance, billing, scheduling, and medical services.
- Provide accurate and timely information to patients regarding their insurance benefits, coverage, and claim statuses.
- Resolve issues related to insurance claim denials, billing discrepancies, and authorization requirements, working closely with both patients and insurance providers.
- Handle inbound and outbound calls from patients and providers, ensuring inquiries are addressed promptly and professionally.
- Assist patients in navigating the healthcare system by providing clear explanations of benefits, co-pays, and deductibles.
- Collaborate with healthcare providers, insurance companies, and internal teams to resolve claims, billing issues, and authorization requests.
- Maintain accurate patient records and ensure compliance with healthcare regulations and privacy laws (e.g., HIPAA).
- Offer empathetic support to patients, ensuring they feel heard and understood while resolving issues in a timely and efficient manner.
Mortgage Loan Processor
IBM
RTP
08.2015 - 04.2019
- Process and review residential mortgage loan applications in alignment with Fannie Mae guidelines, ensuring all required documents are complete and accurate.
- Verify borrower income, assets, employment, and credit history to assess loan eligibility and risk, ensuring adherence to underwriting standards.
- Collect and review financial documents such as W-2s, tax returns, bank statements, and appraisal reports for accuracy and completeness.
- Coordinate with loan officers, underwriters, and borrowers to obtain additional documentation or clarification as needed.
- Ensure all loans are processed efficiently, meeting timelines for closing while complying with regulatory and company policies.
- Manage and track loan files, updating the system with relevant information and ensuring the timely submission of files to underwriting.
- Communicate with borrowers to inform them about loan status, required documents, and next steps in the mortgage process.
- Resolve discrepancies in borrower documentation by working directly with borrowers and third parties to gather missing information.
- Assist in managing a pipeline of loans, prioritizing tasks to meet deadlines and ensure on-time closings.
Education
High School Diploma -
North West Halifax
Littleton, NC06-2000
Skills
- Insurance benefits verification
- Prior authorization processing
- Healthcare industry
- Insurance billing
- Insurance plan verification
References
References available upon request.
Timeline
Reimbursement Specialist
Johnson & Johnson, Janssen Pharmaceuticals
03.2024 - Current
Account Receivable
Corrohealth
11.2022 - 07.2023
Customer Service Representative
BCBS NC
05.2019 - 08.2022
Mortgage Loan Processor
IBM
08.2015 - 04.2019
High School Diploma -
North West Halifax
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