SHANICE SHARPE
Rocky Mount,NC
Summary
Highly experienced Customer Service & Healthcare professional with years of experience proficient in researching and resolving customer problems by utilizing strong problem-solving and communication skills to deliver customer satisfaction. In-depth experience assessing individual needs, up-selling and cross-selling solutions to better serve both the customer and the company. Detail-oriented, multi-tasker that excels in high volume customer service environments Expert in processing payments to minimize outstanding debt, excess fees and interest. Well-versed in investigating claims, verifying information and managing settlements.
Overview
8
8
years of professional experience
Work History
Medical Claims Specialist
Parallon HCA
Louisville, KY
06.2022 - 02.2024
- Evaluate and research cases, coordinate documentation, and research claims for next steps using various systems.
- Perform timely data entry of necessary information to maintain accurate and up-to-date records.
- Conduct adjustments on medical claims, ensuring accuracy and compliance with relevant policies.
- Cross-train on additional intake responsibilities to manage different processes based on inventory levels.
- Perform written outreach to customers to obtain necessary details and documentation for medical claims.
- Research appropriate systems to identify data needed to complete cases efficiently and accurately.
- Ensure compliance with HIPAA regulations and requirements to safeguard sensitive patient information.
- Demonstrate the company's core competencies and values through consistent performance and dedication.
- Manage exposure to PHI sensitive data with a high level of confidentiality and professionalism, considering this role as high-risk.
- Fulfill other duties, responsibilities, and qualifications as required or assigned to support team objectives.
REIMBURSEMENT SPECIALIST
CareMetx
11.2021 - 06.2022
- Contacts insurance companies to verify patient specific benefits
- Ask appropriate questions regarding patients’ benefits and completes data entry and or/appropriate forms to document patients’ benefits coverage
- Performed North Carolina and federal regulations compliance audits related to documentation and reporting.
- Processed online and paper appeal submissions and refund requests.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Promoted consistent accuracy of billing information by reconciling 400+ accounts monthly.
- Reconciled past due accounts achieving 26% reduction in outstanding invoices.
- Verified accuracy of accounts payable payments, resulting in 28% reduction in payment errors and check reissues.
- Verified that the services and products are correctly authorized and that required documentation is on file prior to billing
- Ensured that invoices are submitted for services and products that are properly ordered and confirmed as provided
- Ensured that all required documentation for billing is completed and accurate prior to claim submission
- Adhered to Regulatory / Payor Guidelines and policies & procedures
Customer Service Representative
PNC BANK
08.2019 - 12.2021
- Performed customer service activities and initiatives for a broad range of products, services and problem resolution that occurs across multiple channels for our customers.
- Delivered CARES model to customers and service partners.
- Received, investigated and responded to customer inquiries regarding products, services and issues via all channels through which customers are served.
- Resolved customer service inquiries and issues. Recommended appropriate solutions. Referred complex or reoccurring issues.
- Maintained high levels of customer satisfaction consistent with PNC's core values. Demonstrated commitment to quality through customer and service partner interactions.
- Documented customer interactions and completes service requests to minimize customer effort or additional action
- Ensured maximum client satisfaction by providing exceptional and personalized service to each client, enhancing client satisfaction ratings from 88% to 99.9%
- Worked closely with specialists in multiple branches, managing investment portfolios for over 900 clients with over $15M in assets under care
- Designed and implemented templates of internal financial reports and dashboards for operational departments which increased profits by 50%
CUSTOMER CARE PROFESSIONAL
BLUE CROSS BLUE AND BLUE SHIELD
06.2017 - 08.2019
- Investigated and resolve complex claims matters in coordination with health plan and/or corporate department
- Coordinated the day-to-day work functions, acting as a “go to” person and investigating and resolving complex issues
- Initiated change requests to resolve system configuration questions impacting claims processing; review and test results
- Conducted appropriate auditing processes
- Referenced current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
- Educated members and/or providers on health plan initiatives; train and assist providers regarding proper claims billing procedures
- Provided first call resolution and “own the process” by working with appropriate internal/external resources and ensure the closure of all inquiries
- Documented all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
- Identified trends related to member and/or provider inquiries to respond proactively and provide feedback to management
- Collaborated with other departments on cross functional tasks and projects Maintained performance and quality standards based on established call center metrics including turn-around times
- Handled 100+ calls daily, with duties including signing up new customers, retrieving customer data, presenting relevant product information, and canceling services
- Received an average 92% customer satisfaction rating to date, 19% higher than the company average
Customer Care Specialist
AT&T
09.2015 - 05.2017
- Achieved a 99% customer approval rating with a compassionate and empathetic approach ·
- Stayed up-to-date on new program offerings, and proactively made recommendations to customers based on their interests
- Exceeded personal sales goals by10% on average by setting ambitious and organized goals weekly
- Exceeded quantitative metrics on customer satisfaction, customer retention, and inquiry volume
- Grew existing customer accounts by 31% through exceptional customer service and effective sales techniques
- Quickly triaged incoming calls, and escalated calls when necessary, reducing the average time to resolution by 24% ·
- Actively worked to display a courteous and empathetic attitude to customers, resulting in a net promoter score over 45
Education
Associate of Science - Health Administration
Wilson Community College
Wilson, NC05-2025
Skills
- Proficient Avaya Software knowledge
- Signature verification
- Database Management
- SLA fulfillment
- Accounting systems and controls
- Billing statement review
- A/P and A/R expertise
- Financial Management
- ICD 10 Coding
- Claims
- Copay Collection
- Prior authorization processing
- Excellent administrative abilities
- Claims Adjustments
- Policy understanding
- Google Workspace
- Infection Control Standards
- Technical Support & Computer Skills
- Multi-line phone talent & CRM
- Documentation & Record Keeping Strengths
- Sales proficiency( Upselling & Cross selling)
- Accurate money handling
- Delivery management
- Customer Relations & Product knowledge
- PPE Compliance & Data Entry
- Active Listening & Comprehension
- Teamwork & Collaboration
- Dependable & Responsible
- Training & Development
- Analytical & Critical Thinking
- Customer Complaint Resolution
- Written Communication & Verbal Communication
- Exceptional Customer Service
- Self-Motivated Self Starter
- Typing Speed 45 wpm
- Proficient with desktop/ laptop computer system
- Problem Solving & Work Prioritization
- Time Management & Organization
- Patience & Empathy
- Interpersonal Skills
- Flexibility & Adaptability
- Multitasking
- Service Level Agreements
- Customer Accounts Management
- Call center operations
- Medical Terminology and HIPAA Compliance
- Insurance Knowledge
- Microsoft Office, Microsoft Word, Microsoft Excel, Microsoft Outlook, and Microsoft PowerPoint
- Account management
- Service standard compliance
- EMR/EHR
- Eligibility Verification
Timeline
Medical Claims Specialist
Parallon HCA
06.2022 - 02.2024
REIMBURSEMENT SPECIALIST
CareMetx
11.2021 - 06.2022
Customer Service Representative
PNC BANK
08.2019 - 12.2021
CUSTOMER CARE PROFESSIONAL
BLUE CROSS BLUE AND BLUE SHIELD
06.2017 - 08.2019
Customer Care Specialist
AT&T
09.2015 - 05.2017
Associate of Science - Health Administration
Wilson Community College
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