SHAQUELIA WILSON
Dallas,TX
Summary
Patient Service Representative experienced in high-volume environments. Achieved enhanced patient satisfaction and streamlined operations by managing patient intake, appointment scheduling, and benefits verification while ensuring HIPAA compliance. Leveraged CRM and EMR/EHR systems to coordinate care and resolve complex inquiries, fostering trust between patients and providers.
Overview
10
10
years of professional experience
Work History
Patient Access & Care Coordination Specialist
CHS
Dallas, TX
05.2022 - 06.2026
- Managed 50-70+ multi-channel patient interactions daily via call, chat, and email to facilitate scheduling, intake, verification, and eligibility in compliance with HIPAA.
- Navigated 6+ systems including EMR/EHR platforms, CRM tools, and insurance portals to coordinate care, update records, and resolve complex inquiries.
- Reduced escalations through effective call control and solution-focused communication, improving patient satisfaction.
Prior Authorization Specialist
Concentrix
Dallas, TX
07.2019 - 07.2022
- Leveraged VoIP and auto dialers to optimize queue management, maintaining quick ACW while consistently meeting strict KPIs.
- Recorded patients' pulse, blood pressure and respirations (TPRs) to assess and document important health information.
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
- Recorded findings of inspection process, collaborating with quality team to implement corrective actions.
- Analyzed quality and performance data to support operational decision-making.
- Authored and maintained well-organized, efficient and successful manual test cases for entire team.
- Monitored resolution of bugs, tested fixes, and helped developers tackle ongoing problems by providing QA perspective.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Verified eligibility and compliance with authorization requirements for service providers.
- Read incoming correspondence to ascertain nature of writers' concerns and to determine disposition of correspondence.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Prepared documents and correspondence such as damage claims, credit and billing inquiries and service complaints.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Tracked referral submission during facilitation of prior authorization issuance.
Member Services & Benefits Coordination Specialist
Cigna
Dallas, TX
04.2016 - 01.2019
- Processed 80+ member interactions per shift, addressing benefits, eligibility updates, ID cards, and policy inquiries while ensuring compliance with standards.
- Enhanced member retention by communicating clearly and resolving plan concerns efficiently.
- Supported Cigna members with benefits, eligibility, and coverage inquiries.
- Reviewed claims details and resolved payment and processing questions.
- Coordinated prior authorization requests with providers and internal teams.
Education
Associate of Arts -
Full Sail University
Winter Park, FLSkills
- Patient Support & Healthcare CS
- Eligibility & Claims Support
- Member Services & Benefits Verification
- Eligibility verification
- HIPAA Compliance & Confidentiality
- CRM & EMR/EHR Systems (Epic, Cerner)
- High-Volume Interactions & KP I Tracking
- High-Volume Interactions & KPI Tracking
- Appointment Scheduling & Intake
- Issue Resolution & De-Escalation
- Adaptability & Workflow Optimization
- Accuracy & Attention to Detail
- MS Office, Excel, Outlook, Word
- Training & Development
- Analytical
- Issue resolution
Accomplishments
Gateway Charter Academy, Diploma
Timeline
Patient Access & Care Coordination Specialist
CHS
05.2022 - 06.2026
Prior Authorization Specialist
Concentrix
07.2019 - 07.2022
Member Services & Benefits Coordination Specialist
Cigna
04.2016 - 01.2019
Associate of Arts -
Full Sail University