ShaRhonda McCray
Spanaway,WA
Summary
Highly motivated employee with strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Seeking opportunities to utilize leadership, project management, and professional skills for mutual growth and success.
Overview
14
14
years of professional experience
Work History
Provider Network Administrator 2
Centene Corporation
Tacoma , WA
02.2018 - 12.2023
- Conducts regular site visits in assigned regions to meet or exceed monthly goals. Engages with providers and staff to identify non-compliance with policies/regulations. Evaluate the quality of customer service provided to members.
- Resolved complex provider issues that crossed departmental lines, involving Contracting, Finance, Quality, Operations, and Senior Leadership.
- Independently resolves problems, assessing when escalation is required to senior representatives, supervisors, or other Molina departments. Proactively prevents and manages issues between providers and the Plan. Addresses unpredictable questions, issues, or problems that may arise during visits, ranging from simple to complex or sensitive matters.
- Led efforts in proactively coordinating collaboration sessions among providers, senior leadership, and physicians across different lines of business to effectively address concerns about utilization management, pharmacy services, quality of care delivery, and accurate coding practices.
- Enhanced provider effectiveness by educating and promoting participation in various initiatives such as administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related processes, Provider Quality programs, etc.
Claims Liaison 2
Centene Corporation
Tacoma , WA
02.2018 - 06.2018
- Spearheaded the generation and analysis of reports for providing constructive feedback to claim liaisons.
- Enhanced communication between CIA and claims Liaison team by presenting tracks and trends report in department meetings.
- Facilitated departmental meetings to allocate priorities for claim projects and track their progress until finalization
- Assist with writing work processes and continual auditing of the process to ensure configuration, state mandates, benefits, etc
- Created an interactive learning experience for health care providers to ensure a better understanding of HCA billing system.
- Analyzed claim data to identify areas of concern or potential cost savings opportunities.
- Advised clients on best practices when filing a claim or appealing denied claims decisions.
- Participated in JOC meetings as claims team representative to review and resolve project and critical claim escalations
Corporate Business Office Billing/Insurance Specialist II
Swedish Health Services
Seattle , WA
09.2016 - 09.2017
- Developed and implemented strategies for reducing risk exposures and maximizing profitability.
- Served as subject matter expert for non-standard coverage questions, property damage, and collision.
- Obtained prior authorization for surgical procedures and diagnostic tests including MRI, sleep studies, and chemo by communicating with doctors’ offices.
- Maintained a high level of accuracy in entering data into Epic systems, facilitating efficient processing of corrected claims
Provider Denials Analyst Manager
Multicare Health Systems
Tacoma , WA
07.2013 - 07.2016
- Achieved a high success rate in appealing and overturning Medicare as well as Medicaid Managed Care denials, resulting in improved revenue generation.
- Educated and equipped Denials Management team manager with knowledge of Appeals process, Reports, Operating systems, and resource utilization.
- Performed cost-benefit analysis to evaluate project feasibility.
- Scheduled meetings with Provider Reps for Amerigroup, Medicaid, Medicare, and commercial plans to deliver comprehensive data analysis and reports addressing outstanding claim denial inquiries.
- Implemented The Lean Move on Sharepoint which streamlined the process of tracking claims movement for Provider Reps
- Developed actionable roadmaps for improving workflows and processes.
- Utilized formulas to extract data from queries into Excel spreadsheets.
Insurance Follow-Up Specialist I
Multicare Health Systems
Tacoma , WA
06.2010 - 06.2013
- Maximized revenue for the healthcare facility by quickly resolving Payer disputes over non-payment of legitimate insurance claims.
- Identified billing patterns, keeping abreast of billing rules for quicker resolution of insurance issues and spotting delays in processing
- Facilitated communication in all areas of finance by interacting with insurance companies, colleagues, patients, and team leads.
- Identified and corrected errors related to billing, coding, and reimbursement from insurance companies.
- Recommended improvements in products, services, and billing methods to management to prevent future problems.
- Liaised between customers and retail buyers to expedite orders and meet customer demands.
- Prepared and evaluated CRM reports to identify problems and areas for improvement.
Education
Degree in Medical Billing & Coding -
Everest College
01.2008
Degree in Phlebotomy -
Clover Park Technical College
01.2005
Skills
- Performance-Focused
- Efficiency Enhancements
- Claims Management
- Invoice Management
- Code Implementation
- System Performance Analytics
- Compliance Management
- Procedure Implementation Oversight
- Educational Course Deployment
- Claims Management Liaison
- Financial Oversight
- Strategic Leadership
- Educational Program Design
Professional Highlights
- Results Driven
- Guaranteed Process Improvements
- Claims, Billing, Coding, and System Analytics
- Regulatory Compliance and Procedures efficient
- Training course Implementation
- Advanced Claims Liaison
- Financial Management/Leadership
Affiliations
- Epic Super User Certified 2011 MultiCare Health Systems
- Crucial Conversations Certified 2013 MultiCare Health Systems
- Best Place to work CoManager MultiCare Health Systems 2013
- Board member of the Diversity Equity and Inclusion committee 2021-2023 Centene Corporation.
- CAHPS Certified Member 2022 Centene Corporation
References
References available upon request.
Timeline
Provider Network Administrator 2
Centene Corporation
02.2018 - 12.2023
Claims Liaison 2
Centene Corporation
02.2018 - 06.2018
Corporate Business Office Billing/Insurance Specialist II
Swedish Health Services
09.2016 - 09.2017
Provider Denials Analyst Manager
Multicare Health Systems
07.2013 - 07.2016
Insurance Follow-Up Specialist I
Multicare Health Systems
06.2010 - 06.2013
Degree in Medical Billing & Coding -
Everest College
Degree in Phlebotomy -
Clover Park Technical College
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