Shankerrya L. Shaw
Bessemer,AL
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
6
6
years of professional experience
Work History
Sr. Health Management Specialist (Contractor)
Blue Cross and Blue Shield of AL
Birmingham, AL
01.2021 - Current
- Answers questions from staff and provides guidance regarding payment of claims;
- Research and work with other areas of Company to resolve issues related to Case
- Management, Utilization Management, Healthcare Analytics and Business Support activities of Health Management Completes assigned projects timely and accurately Work with oversight of clinical review staff when performing Utilization Management tasks Learn and maintain knowledge of all Health Management programs (Utilization
- Management, Business Support, Healthcare Analytics and Case Management) Acts as liaison between Health Management and other areas of Company Maintains current knowledge of trends and technology associated with job Gains knowledge of Utilization Management principles that govern job Provides feedback and implements new processes to enhance area performance Cross trains with other non-exempt Health Management staff to promote efficiency
- Cultivated positive relationships with vendors to deliver timely and cost-effective supply of services and materials.
- Developed and updated tracking spreadsheets for process monitoring and reporting.
Data Integration Analyst (Contractor)
RxBenefits
10.2020 - 01.2021
- Handle exchange of eligibility data between clients, PBM’s, and other 3rd parties
- Handle exchange of claim data between PBM’s and clients or 3rd parties
- Research data and member related issues
- Receive calls from both internal and external customers regarding data file issues
- Assist with operational aspects of implementing changes to existing clients
- Serve as resource to others
- Track projects to ensure that data files are received and processed on-time
- Use Microsoft Excel and text editor (Notepad++) to review, analyze, and manipulate data
Provider Enrollment Specialist
The SSI Group
08.2019 - 01.2020
- Virtual trainer for over 100 clinical providers on how to maintain Council for Affordable
- Quality Healthcare, IN
- (CAQH) credentialing process on new providers
- Presented standard operating procedure training manuals for current and incoming enrollment specialist team members
- Administered and maintained Proof Point SMTP Mail Gateway platform
- Processed enrollment requests submissions for 5000 plus national payers to include
- Tricare, Medicare, Medicaid, Kaiser Permanente, Dignity Health, Providence Health,
- SSM Health, Magellan Health, Blue Cross Blue Shield, and Anthem
- Trained and monitored new team members for Super User training skills, training quality assurance, and professionalism
- Completed all phases of implementation lifecycle (planning, design, build, test, implement and development) for new client and existing clients
- Strong written and oral communication, negotiation, and documentation skills with executive leadership, clinical staff or clinical providers and fellow team member of various levels and roles
- Led virtual and onsite weekly meetings with Enrollment Department Director to provide team members program updates while applying management concepts
- Performed enrollment fundamentals, deadlines, go-lives with outpatient clinics and health care professionals
- Maintained accurate reporting of enrollment activities for doctors, nurse practitioners, medical assistants
- Submitted National Provider Identifier (NPI) requests for providers and clinics to maintain accurate NPI files.
EDI Verification Analyst
The SSI Group
Mobile, AL
06.2018 - 07.2019
- Use sFTP and encryption software to securely access and deliver files
- Reviewed logs for schedules and errors
- Program batch and real-time processes to support electronic exchange of eligibility, enrollment, claim, payment, and acknowledgement transactions
- Developed and presented continuing education and customer service training meeting materials using Microsoft Office tools (PowerPoint and Excel) to providers and fellow employees
- With integrated solutions, eliminate back and forth of multiple, disparate systems, enabling users to save time, maximize resources, and focus their efforts on what matters most: delivering exceptional patient care
- Provided health systems with revenue cycle management tools and Protected Health
- Information (PHI) and Personally Identifiable Information (PII) necessary to develop and maintain lean processes
- Secured access to HIPAA and American National Standards Institute standard edits
- Maintained compliance with data retention requirements and seamlessly gain access to information necessary for billing and appealing claims
- Managed team projects on schedule, scope and within budget while delivering high quality and high customer satisfaction
- Processed and posted activities of secure electronic data interchange files submitted by outside Trading Partners, correct identified errors, and reconcile data discrepancies, to ensure timely capture of medical claims with Trading Partners
- Catalog and maintained and secured electronic data interchange processing log for more than 100 plus Trading Partner that submits claims electronically
- Decreased denials by leveraging the tool’s leading clean claim and first-time payer acceptance rates
- Checked eligibility and benefits (270/271), file medical claims (837P and I), receive electronic remittance (835), and review claim status (276/277)
- Worked with over 900 direct payer connections and more than 100,000 discrete edits to handle clinical health provider’s claim submission and processing
- Responsible for the integration of any new vendor relationship using secure Electronic
- Data Interchange and file layouts for eligibility, accumulator, claim detail, and other files
- Examples of such files include flat file in delimited or fixed width .txt, .xlsx, .csv, or new file layouts
- Collaborated with and securely provided PHI and PII to clinical staff on behalf of payers such as Tricare, Medicare, Medicaid, Kaiser Permanente, Dignity Health, Providence
- Health, SSM Health, Magellan Health, The Health Exchange (Cerner Corporation), Blue
- Cross Blue Shield, and Anthem.
- Audited production reports, tracking data entry and processing errors.
- Improved office operations by automating client correspondence, record tracking and data communications.
- Participated in weekly conference calls with management to discuss department updates and strategies.
- Reviewed and analyzed project spending throughout project life cycle.
- Identified and resolved payment issues between providers and third parties.
Internship Student
Mobile Infirmary
Mobile, AL
06.2017 - 06.2018
- Calling in issue tickets to command center when technical issues arise Assisted End users with their preference list and building their smart phrases Supported physician on routing messages to nurse pool and clearing there in basket Experienced in Medicaid enrollment and billing processes
- Providing issue resolution and updates for end users and working with other trainers to make appropriate changes to training materials Aided clinical floor with their in-baskets
- Completed research, compiled data, updated spreadsheets, and produced timely reports.
- Sorted, organized, and maintained files.
- Answered and transferred incoming telephone calls, taking messages for various staff members.
Education
Bachelor of Science - Health Informatics, Information Systems
University of South Alabama
Mobile, AL08.2018
Skills
- MS Office
- FTP Software
- Salesforce
- Go-Live
- Notepad
- Track IT
- Heat
- JIRA
- Troubleshooting
- JIVA/Navigator
- Outlook
- ASCII Text files
Timeline
Sr. Health Management Specialist (Contractor)
Blue Cross and Blue Shield of AL
01.2021 - Current
Data Integration Analyst (Contractor)
RxBenefits
10.2020 - 01.2021
Provider Enrollment Specialist
The SSI Group
08.2019 - 01.2020
EDI Verification Analyst
The SSI Group
06.2018 - 07.2019
Internship Student
Mobile Infirmary
06.2017 - 06.2018
Bachelor of Science - Health Informatics, Information Systems
University of South Alabama