Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Shannele Wilson

Tampa,FL

Summary

Seasoned collaborator experienced in meeting needs, improving processes and exceeding requirements in team environments. Diligent worker with strong communication and task prioritization skills. . Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills. Highly analytical with a talent for solving complex problems and leveraging data to create actionable business insights.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Provider Credentialing Consultant

Humana
04.2015 - Current
  • Identified and implemented improvements to streamline credentialing processes and enhance efficiency.
  • Conducted primary source verifications such as background checks and board certifications for prospective providers
  • Periodically reviewed and re-verified the credentials of existing providers in Xcelys, Cactus, Wintergate and additional databases to ensure ongoing compliance with CAQH and CMS regulations.
  • Serve as a liaison between the provider and the healthcare organization, facilitating the credentialing process

Referral Intake Specialist

Humana at Home (Humana, Inc.)
08.2014 - 04.2015
  • Assessed clients' needs and determined eligibility for intake services.
  • Answered phone calls and provided new clients with required paperwork to initiate service.
  • Maintained accurate, up-to-date client records for reliable reference and communications.
  • Completed intake assessment forms and filed clients' charts.
  • Streamlined intake systems, resulting in reduced errors and improved speed.
  • Provided support to social service clients in navigating available resources.

Configuration Specialist

Express Scripts Mail Pharmacy/Aerotek
08.2013 - 06.2014
  • Analyzed business requirements to design and implement benefit changes, ensuring alignment with client needs.
  • Participated in various team projects, demonstrating the ability to work collaboratively and effectively.
  • Managed plan benefits coding changes, UAT test execution, and validation for benefit design requests via Qnxt .
  • Coordinated responses to audits and ensured compliance with updated workflows and protocols .
  • Configured customized benefits enrollment platforms, assisting in implementation and maintenance. Kept CM work aligned with project's configuration management plan.

Education

Bachelor Of Applied Science - Management Organizational And Leadership

St. Petersburg College
Largo, FL
01.2020

Associate Of Science - Business Administration

Hillsborough Community College
Tampa, FL
01.2009

Skills

  • Microsoft Office (Word, PowerPoint, Excel, Access)
  • CAS
  • KPI (Key Performance Indicator)
  • User
  • SQL
  • QNXT
  • Provider contract Performance Monitoring
  • Project coordination
  • Professionalism and etiquette
  • Administrative support
  • CAQH/PECOS
  • Project Planning
  • Business Administration
  • Training and development

Certification

  • Business Administration - Business Specialist Certificate, Hillsborough Community College (2009)


Timeline

Provider Credentialing Consultant

Humana
04.2015 - Current

Referral Intake Specialist

Humana at Home (Humana, Inc.)
08.2014 - 04.2015

Configuration Specialist

Express Scripts Mail Pharmacy/Aerotek
08.2013 - 06.2014

Bachelor Of Applied Science - Management Organizational And Leadership

St. Petersburg College

Associate Of Science - Business Administration

Hillsborough Community College

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Shannele Wilson