Shannon Martin
Summary
A seasoned professional with extensive experience in human services, HIPPA compliance, and medical practices, adept at navigating complex regulatory landscapes and providing comprehensive support to clients and healthcare organizations. Strong track record of success in building and managing teams, implementing innovative programs, and ensuring high-quality patient care. Demonstrated expertise in program development, policy implementation, and data analysis, contributing to improved outcomes and organizational efficience.
Overview
10
10
years of professional experience
Work History
CASE MANAGEMENT QAQC
TRIALCARD / MERCALIS
01.2023 - Current
- Reviews and evaluates the performance of all representatives using an approved quality scorecard in the areas of patient experience, Federal and Drug Administration (FDA) regulations of Adverse Events (AE)/Product Complaints (PC) and Health Insurance Portability and Accountability Act (HIPAA) compliance, and specific program policies and procedures.
- Analyzes potential call trends through call monitoring and works with the internal departments to develop solutions to improve the patient experience.
- Maintains a thorough understanding of company Standard Operating Procedures (SOPs), process and policy requirements.
- Prepares and analyzes internal quality reports for management staff to review.
- Manages disputes and call requests received through ServiceNow portal.
- Participates and/or facilitates internal and external calibrations to identify Client’s needs and expectations.
- Facilitates new hire training and introduces program quality standards and expectations.
- Prepares call records and/or corresponding documents and participates in internal and external client audits.
- Handles requests to locate specific call records from the call recording system and provides reports of findings and edit call recordings to remove Protected Health Information as requested or according to contractual agreements.
- Participates in internal department meetings as needed.
- Contributes to the design of call monitoring formats and Quality standards.
- Identifies and reports pharmacovigilance information as required by client(s) (i.e., Adverse Events).
- Conducts miscellaneous tasks or projects as assigned.
CARE COORDINATOR
AEROTEK (TRIAL CARD)
01.2019 - 01.2023
- Regionally aligned to serve as an expert on a complex benefit program comprised of inpatient, outpatient, and home health benefits. Responsible for sharing benefit knowledge with health care providers and at times, patients/caregivers.
- Assessed and enroll patients in applicable financial assistance opportunities when patient meet eligibility criteria to offset patient cost sharing.
- Served as an advocate to patients regarding eligibility requirements, program enrollment, affordability support, and general access for prescribed therapy.
- Served as direct point of contact to health care providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient.
- Strong working knowledge and ability to understand, share, and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA, and DOD); with expertise in Medicare Part B
- Acts as an assigned liaison to client contacts (e.g., regional contact for sales representatives)
- Maintained records in accordance with applicable standards and regulations to the programs/promotions.
- Liaison between Program Management, other internal stakeholders, and healthcare providers
- Provided unparalleled customer service, with attention to detail, while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources.
PROVIDER DATA SPECIALIST
UNITED HEALTH CARE
01.2016 - 01.2019
- Assisted with incoming calls from patients regarding statements received from hospital staff.
- Complete registration of all new accounts in company software
- Worked daily reports on small balance accounts to determine responsibility.
- Completed day to day account updates using medical grade computerized systems.
- Ensured quality of customer service and maintained excellency in recording patient information for hospital records.
- Professional and courteous telephone skills and the ability to manage multiple projects at one time.
UNDERPAYMENT ANALYST
CONE HEALTH
01.2015 - 01.2016
- Responsible for the analysis of insurance payments to determine if payments meet contractual terms.
- Determined reasons for underpayments which affected reimbursement such as registration issues, denials, posting errors, and other issues, and coordinate resolution with appropriate department.
- Review outstanding insurance accounts receivable to determine if payments follow timing specified in contracts.
- Completed all functions of reporting via Excel.
- Escalate contract issues to the Supervisor.
- Assisted and compiled information to implement process for routing all correspondence to outside vendors.
- Perform appropriate follow up with payors for payment.
- Epic trained in registration, charge entry as well as workflow management.
- Professional and courteous telephone skills and the ability to manage multiple projects at one time.
Education
Phlebotomy Certification
Good Nursing And Medical Training
Norcross, GAMedical Billing & Career Center course completion - undefined
Skills
- Communication
- Leadership
- Coachability
- Organizational Skills
- Multi-tasking
- Competitive Drive
- Data Gathering
- Report Creation
- Written Communication
- Verbal Communication
- Empathetic Approach
- Consultative Approach
- Time Management
- Analytical Thinking
- Technical Skills
- Creative Thinking
- Friendly, positive attitude
- Teamwork and collaboration
- Customer service
- Problem-solving
Timeline
CASE MANAGEMENT QAQC
TRIALCARD / MERCALIS
01.2023 - Current
CARE COORDINATOR
AEROTEK (TRIAL CARD)
01.2019 - 01.2023
PROVIDER DATA SPECIALIST
UNITED HEALTH CARE
01.2016 - 01.2019
UNDERPAYMENT ANALYST
CONE HEALTH
01.2015 - 01.2016
Medical Billing & Career Center course completion - undefined
Phlebotomy Certification
Good Nursing And Medical Training
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