Shante Wesley
Desoto,Texas
Summary
Obtain a position where I can maximize my skills, quality assurance, program development and training. Reliable Submission Officer with solid background in document handling, process management and compliance procedures. Possess strong organizational skills, adept at managing multiple tasks simultaneously to meet strict deadlines. Demonstrated success in improving submission processes, enhancing efficiency while maintaining high-quality standards. Known for problem-solving aptitude and commitment to accuracy.
Overview
16
16
years of professional experience
Work History
Claims Submission Spec
KCI INC DBA 3M
San Antonio, TX
06.2024 - Current
- Verified accuracy of submitted documents against established guidelines and standards.
- Created templates for document submission forms, ensuring compliance with relevant laws and regulations.
Claims Submission Spec
Solventum
10.2023 - Current
- Manage the insurance claim process
- Verify and check eligibility including investigating the insurance claim and or calling to request additional information needed to process timely audits
- Manage litigation on assigned files
- Prepare reports and other written correspondence for internal and external users
- Participate in mediations, seminars, field unit meetings and complete other tasks as needed
- Travel as required.
Owner Operator of All Star Nutrition
self
Desoto, TX
11.2021 - 07.2024
- Managed daily operations of business, including hiring and training staff.
- Identified new opportunities for growth, expansion, and diversification.
- Maintained relationships with existing clients by providing superior customer service.
Care Review Processor
Molina Healthcare
San Antonio, TX
05.2013 - 01.2017
- Provides telephone, clerical and date entry support for the Care review Team
- Provides computer entries of authorization request/provider inquire such as eligibility/benefits
- Responds to request for auth of services submitted via phone, fax and mail according to Molina policy
- Prepare and send member eligibility verification letter.
Medical Office Specialist
Total Health Primary Care
Schertz, TX
09.2012 - 02.2013
- Manage a team to ensure rapid customer turnaround
- Schedule, cancel and change patient appointment
- Processed super bills for physician
- Answer high volume calls in a timely manner.
Night Teller
Wells Fargo
San Antonio, TX
02.2009 - 03.2010
- Process large sum of currency from night drops
- Work in fast pace environment, bundle currency for transport
- Self-audit for accuracy and discrepancies.
Education
Medical Office Specialist Billing And Coding - Medical Science
KAPLAN COLLAGE
San Antonio, TX04-2012
Skills
- Demonstrate responsibility
- Competence
- Attention to detail
- Efficient in Excel
- Word
- Outlook
- Microsoft tools
- Coding CPT 10 and ICD-p
- Office machines
- CCA
- WRMS
- QNXT
- Verbal Communication
- Document Review
- Payment Collection
- Eligibility Determination
References
Available upon request
Timeline
Claims Submission Spec
KCI INC DBA 3M
06.2024 - Current
Claims Submission Spec
Solventum
10.2023 - Current
Owner Operator of All Star Nutrition
self
11.2021 - 07.2024
Care Review Processor
Molina Healthcare
05.2013 - 01.2017
Medical Office Specialist
Total Health Primary Care
09.2012 - 02.2013
Night Teller
Wells Fargo
02.2009 - 03.2010
Medical Office Specialist Billing And Coding - Medical Science
KAPLAN COLLAGE