Shanika Williams
Chicago,IL
Summary
Detail-oriented and analytical Recovery Resolution Analyst with experience in financial services, specializing in identifying, investigating, and resolving discrepancies in payment and claims processes. Proven track record in mitigating financial losses, enhancing recovery workflows, and ensuring compliance with regulatory standards. Adept at cross-functional collaboration, root cause analysis, and delivering accurate, data-driven solutions in high-pressure environments. Strong communication and problem-solving skills with a commitment to operational excellence. Proficient in Citrix, Epic, QLS, and On Base systems, with a comprehensive understanding of HIPAA regulations and patient confidentiality. Demonstrates the ability to streamline workflows, enhance data accessibility, and reduce errors. Seeks to leverage expertise in a dynamic healthcare setting to drive efficiency and provide high-quality patient care.
Overview
6
6
years of professional experience
Work History
Recovery Resolution Analyst
Insight Global
02.2025 - 05.2025
- Managed a high volume of cases simultaneously while maintaining exceptional attention to detail and adherence to established timelines for resolution.
- Maintained comprehensive documentation of all cases handled, ensuring accuracy and accessibility of information for future reference.
- Understand and navigate National Association of Insurance Commissioners (NAIC) and Medicare order of benefits rules.
- Performed online eligibility verifications.
- Update Core operating system (Facets).
- Updated and tracked results via Excel spreadsheets.
- Coordinating benefits for Hospice coverage.
Reconsideration Analyst 1
J29 INC.
11.2024 - 02.2025
- Coordinated the delivery of redetermination case files and reconsideration decisions from and to stakeholders, e.g., appellants and Part D plans
- Builds a reconsideration case file from evidence submitted and received, and analyzes each case to ensure it meets the requirements for a valid reconsideration request as mandated by Centers for Medicare and Medicaid Services (CMS) or other customer entities
- Analyzes and makes an analysis on the validity of each appeal
- Accurately inputs appropriate data regarding enrollee appeal requests and Part D plan case files into the applicable required systems
- Requests Appointment of Representation documents for reconsideration requests from appellants
- Identifies any suspected instances of fraud and/or abuse and immediately inform management of such issues
- Stays abreast of changes in regulations and practices, policies and procedures
- Participates in special projects and performs other duties as assigned
- Non- Exempt Full Time, includes weekend and holiday rotation; may also include overtime opportunities
HIM Medical Records QA/ Document Imaging Specialist
Aston Carter/ TEKSYSTEMS-Remote
02.2024 - 05.2024
- Ensure accuracy in medical records QA, implementing rigorous document imaging protocols
- Streamlined QA workflows, reducing processing time by measurable results
- Enhanced document imaging accuracy, improving data accessibility
- Reviewed medical records for compliance and accuracy, minimizing errors
- Developed and maintained precise document imaging standards
- Knowledge of Citrix, Epic, and OnBase systems
- Confidentiality of patient records
- Understanding of HIPPA
- Audited/ Verified up to600 documents within8-hour shift
COB Commercial/ Medicare Specialist
Change Healthcare/ Optum- Remote
08.2022 - 05.2023
- Processed complex COB claims, ensuring accurate coordination between commercial and Medicare policies
- Streamlined workflows, reducing processing time and enhancing efficiency
- Resolved intricate billing discrepancies, leading to improved claim accuracy and substantial cost savings
- Consistently met and exceeded performance targets
- Meticulously reviewed and validated Medicare and commercial insurance policies, ensuring compliance with regulatory requirements and minimizing errors
- Knowledge of HIPPA and patient confidentiality
- Using investigative skills for locating member coverage through Insurance portals
- Verifying CMS member's coverage through the CMS website
- Managed over50 claims daily, conducting prospective and retrospective reviews while effectively communicating with insurance providers and verifying member coverage
MSP Eligibility Specialist
Discovery Health Plans/ Multiplan- Remote
11.2019 - 08.2022
- Analyzed complex MSP eligibility cases, ensuring accurate determinations and compliance with regulations
- Streamlined processes, reducing turnaround time significantly
- Optimized eligibility verification procedures, leading to a substantial increase in claim processing efficiency and customer satisfaction rates
- Partnered with cross-functional teams to resolve intricate eligibility disputes, fostering improved communication and expedited resolution times
- Meticulously reviewed and validated eligibility documentation, maintaining high accuracy standards and minimizing errors in benefit determinations
- Outbound calls to member's other insurance to verify primary or secondary payer
- Maintaining100% accuracy in validation with other insurance coverage
Education
Medical Billing & Coding -
University of Phoenix
Tempe, AZ12-2024
Associates in Health Administration - Electronic Health Records
University of Phoenix
Tempe, AZ09.2017
Electronic Health Records - undefined
University of Phoenix
Tempe, AZ06.2017
Skills
- Compliance Understanding
- Workflow Coordination
- Data entry
- Excel/ One Note/ Sharepoint
- Microsoft Word/ Windows/ Outlook
- Telephone etiquette
- HIPPA
- Quality Assurance
- Medicare/ Commercial/ Hospice Insurance Verification
- Team collaboration and leadership
- Attention to detail
- Documentation and reporting
- Critical thinking
- Decision-making
- Data research and validation
- NAIC
INTERNSHIPS
- MEDICAL RECORDS CLERK
- Circle Family Health Care
- Jan2016 - Jan2017
- Chicago, IL
Timeline
Recovery Resolution Analyst
Insight Global
02.2025 - 05.2025
Reconsideration Analyst 1
J29 INC.
11.2024 - 02.2025
HIM Medical Records QA/ Document Imaging Specialist
Aston Carter/ TEKSYSTEMS-Remote
02.2024 - 05.2024
COB Commercial/ Medicare Specialist
Change Healthcare/ Optum- Remote
08.2022 - 05.2023
MSP Eligibility Specialist
Discovery Health Plans/ Multiplan- Remote
11.2019 - 08.2022
Associates in Health Administration - Electronic Health Records
University of Phoenix
Electronic Health Records - undefined
University of Phoenix
Medical Billing & Coding -
University of Phoenix
Similar Profiles
Laura K. MarineLaura K. Marine
Occupational Therapist at Insight GlobalOccupational Therapist at Insight Global
Shondale LuckettShondale Luckett
Cloud Engineer at Insight GlobalCloud Engineer at Insight Global
NDOLA Q. CARLESTNDOLA Q. CARLEST
Grants and Contracts Consultant at Insight GlobalGrants and Contracts Consultant at Insight Global
Shea NolanShea Nolan
Childcare Provider at FreelanceChildcare Provider at Freelance
ZAK SUTTERZAK SUTTER
Account Executive at TrustRadiusAccount Executive at TrustRadius