Sharese Jackson
Baltimore,MD
Summary
To obtain a challenging and rewarding position within an organization offering opportunities for growth and advancement.
Overview
17
17
years of professional experience
Work History
Intake Coordinator
Highmark Blueshield
08.2021 - 09.2022
- Completed intake assessment forms and filed clients' charts.
- Answered phone calls and provided new clients with required paperwork to initiate service.
- Collected, verified, recorded and processed client demographics, insurance payments, and referral information.
- Communicated with referral sources, physicians, and associated staff to check documentation for proper signatures.
- Supported office staff and operational requirements with administrative tasks.
- Entered referrals into appropriate system based on type of referral obtained.
- Skilled at working independently and collaboratively in a team environment.
Traditional II Customer Service Representative
Blue Cross And Blue Shield OfbPA
09.2005 - 11.2008
- Answered various customer inquiries from doctors and hospitals regarding products, benefits and eligibility
- Resolved a number of medical claims
- Researched inquiries to ensure positive customer relationships
- Coordinated and communicated with team members and other areas of the corporation to resolve inquiries
- Organized and utilized all internal communication and training materials to respond to customer inquiries
- Exceeded productivity and quality standards as determined in the service area
- Processed numerous claim transactions accurately and efficiently.
- Answered constant flow of customer calls with minimal wait times.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Updated account information to maintain customer records.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Responded to customer requests for products, services, and company information.
- Clarified customer issues and determined root cause of problems to resolve product or service complaints.
- Participated in team meetings and training sessions to stay informed about product updates and changes.
- Utilized customer service software to manage interactions and track customer satisfaction.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Investigated and resolved customer inquiries and complaints quickly.
- Promptly responded to inquiries and requests from prospective customers.
- Met customer call guidelines for service levels, handle time and productivity.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
Specialist – Appeals
Maximus Federal Services
12.2013 - 01.2017
- Makes informal resolution determinations for appeals based on analysis of information submitted by the appellant, conversations with appellant, information derived from CMS databases
- Analyzes appeals’ data independently using federal and/or state laws and/or regulations, along with technical direction, guidance, tools, and SOP’s provided by the client
- Confirms the accuracy of appeal data and evaluate in light of proposed resolution
- May research appellant/data/reporting problems and modify the existing system
- Performs telephone outreach to the appellants to explain the results of the informal resolution determination and answer any adjudication-related questions
- Identifies trending patterns and advises SMEs and Sr
- Appeals Specialists of areas in need of improvement accompanied by proposed solutions
- Works closely with SMEs to develop and implement internal procedures and policy communications, workflows, quality control documents, training materials and job aids
- May serve as consultant to the other areas of project
- Offers suggestion in discretionary matters to the client for a final decision on appeal outcome
- Examines eligibility determination notices for evidence of inconsistencies that are not readily apparent and that can only be determined by thoughtful examination of letter language
- Identifies issues, i.e
- Expired inconsistencies, that require specialized subject matter expertise and escalates these issues with proposed solutions to Subject Matter Experts (SME).
Business Service Coordinator II/ Financial Clearance Specialist
Geisinger Health Systems
04.2009 - 03.2012
- Provided financial counseling to patients/families
- Provided coordination and completion of patient billing and collection functions
- Assisted controls assigned self-pay accounts receivable by working with the patients, providers, departmental staff and/or insurance company as appropriate
- Maintained a close working relationship with the staff of the assigned clinical departments, to ensure clear communication and handling of all patients financial needs
- Coordinated Revenue Cycle processes as they occur in the clinic setting
- Acts as a liaison for all financial matters to insurance companies, GHS departments, patients and/or other Revenue Cycle teams/departments
- Completed daily schedules for the Hematology/Oncology Dept
- Obtained Pre-certifications for patient chemotherapy treatments/ Genetic testing /Rheumatology /Pulmonary / Gynecology Depts.
Claims Analyst/Processor
Blue Cross of Northeastern Pennsylvania
09.2005 - 02.2008
- Handled various customer inquiries and problems
- Processed numerous claim transactions accurately and efficiently
- Resolved routine problems using business knowledge and experience
- Participated in team-building sessions
- Produced clear and effective written materials
- Organized work and information in a well thought out manner ensuring deadlines were met.
Education
LPN Program -
Wilkes-Barre Vo-Tech Practical Nursing LPN Program
Wilkes-Barre, PA01.2008
Essex County College
Newark, NJ01.2001
A+ Certification -
PC LAN Solutions-A+ Certification
Linden, NJ01.2000
Skills
- Customer Service
- Cashier
- MS Office Suite
- Netscape
- TRIS
- Isaac
- Windows
- Central Reservation System (CRS)
- Global Distribution System (GDS)
- Rate Create
- Imaging
- E imaging
- PC Payroll for Windows
- Mainframe
- Rumba
- PMEI/PMCI
- I Query
- Aim
- Acrobat Reader
- INSINQ
- Highmark BlueShield OSCAR Claims System & Medical Policies & Core Port ICD-9/HCPC/CPT CODING
- EPIC
- Prelude
- Cadence
- IDX
- Siemens
- Epic
- Mosaiq
- Navinet
- Promise
- Multi-Line Phone Systems
- Inventory Management
- Patient Scheduling
- Employee Supervision
- Data Entry
- Payroll Administration
- Payroll and Budgeting
- Support Services
- Multitasking and Organization
- Phone and Email Etiquette
- Workflow Planning
- Decision-Making
- Handling Complaints
- Microsoft Office
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Quote
Price is what you pay. Value is what you get.
Warren Buffett
Timeline
Intake Coordinator
Highmark Blueshield
08.2021 - 09.2022
Specialist – Appeals
Maximus Federal Services
12.2013 - 01.2017
Business Service Coordinator II/ Financial Clearance Specialist
Geisinger Health Systems
04.2009 - 03.2012
Traditional II Customer Service Representative
Blue Cross And Blue Shield OfbPA
09.2005 - 11.2008
Claims Analyst/Processor
Blue Cross of Northeastern Pennsylvania
09.2005 - 02.2008
LPN Program -
Wilkes-Barre Vo-Tech Practical Nursing LPN Program
Essex County College
A+ Certification -
PC LAN Solutions-A+ Certification
Similar Profiles
Gisele StewartGisele Stewart
Provider Account Liaison at Highmark BlueShield Of Northeastern New YorkProvider Account Liaison at Highmark BlueShield Of Northeastern New York
Paul A. Palombo IIIPaul A. Palombo III
Senior Decision Support Consultant – Client Analytics and Consulting at Highmark BlueCross BlueShield of WNYSenior Decision Support Consultant – Client Analytics and Consulting at Highmark BlueCross BlueShield of WNY
Louis JosephLouis Joseph
Blue Card Senior Claims Processor at Highmark BlueCross BlueShield of WNYBlue Card Senior Claims Processor at Highmark BlueCross BlueShield of WNY
Devin S. SmithDevin S. Smith
Pet Sitter at Friends and FamilyPet Sitter at Friends and Family
Geron BrooksGeron Brooks
Substitute Teacher, Relay Elementary School at Kelly EducationSubstitute Teacher, Relay Elementary School at Kelly Education