Shari Bell
Ocoee
Summary
Highly skilled Senior Quality Specialist with experience in managing quality control processes and implementing quality improvement strategies. Strengths include strong analytical skills, keen problem-solving abilities, and comprehensive knowledge of industry standards and regulations. Previous roles have demonstrated significant impact through the successful enhancement of product quality and efficiency in operations.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Senior Quality Specialist
CareMetx
Lake Mary
06.2023 - Current
- Lead quality initiatives and program findings from analysis through resolution, guiding cross‑functional teams through problem solving and long‑term corrective action plans.
- Develop and implement SOPs, Job Aid workflows, and updated quality frameworks that improve clarity, accuracy, and operational consistency across departments.
- Created, refined, and standardized audit and scoring language, strengthening measurement reliability and reducing interpretation variance.
- Train and coach staff on new processes, compliance changes, and updated audit expectations, ensuring team readiness and sustainable adoption.
- Manage rollout of program updates, coordinating communication, documentation, timelines, and stakeholder alignment across the organization.
- Serve as the lead presenter for Quality Department compliance rollouts, translating complex regulatory requirements into clear, actionable guidance.
- Partnered with leadership to analyze performance trends and recommend process improvements, fostering continuous improvement across quality programs.
Sr. Reimbursement Case Manager
CareMetx/ Novartis Pharmaceutical Corporation
Lake Mary
09.2020 - Current
- Determines prior authorization for medication, covered services, provider offices, and alternative facilities.
- Initiate referrals to patient financial assistance foundation programs and copay support programs.
- Evaluated 8-10 cases for various providers, ensuring financial assistance coverage for underinsured patients.
- Conducted benefit investigations to verify eligibility and claim status for commercial and government insurance accounts and pharmacy benefit managers.
- Allocated financial assistance programs that distributed copay discount cards to pharmacies for prescription medications.
- Researches CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy
- Uses Connect software systems to manage case load, add and distribute information to electronic medical records.
- Experience with researching trends using root cause analysis and corrective action plans.
- Reviewed quality calls using Five9 Virtual Observer Software, reporting data on current trends to inform organizational strategies.
- Actively maintains current working knowledge of CPT, ICD-10 coding principles, government regulation, protocols and third-party requirements regarding billing.
Lead Regional Care Coordinator
Magellan Complete Care/ Magellan Health Services
Orlando
06.2014 - 03.2020
- Successfully managed statistical data key metric reports for over 500 HIV/AIDS member cases in all seven regions in Florida.
- Developed and implemented new automated tracking system for reported cases of members whom requested nutritional education and council under the Healthy Behaviors Enrollment Program.
- Communicated and assisted all levels of management with patient-provider engagement projects.
- Elevated medical records and claims related to fraud, waste, and abuse.
- Conducted staff meetings with team members to review SOPs, address workflow inconsistencies, and discuss concerns, ensuring documentation was recorded for upper management review.
- Cross-trained in various departments to support resolution of backlogs, ACHA and customer complaints, authorization appeals, and maintenance of transportation vendor list.
- Trained and retrained new and current employees on care coordination and utilization processes.
- Coordinate Multi-disciplinary meetings for providers, members, and care managers to discuss support services for the high risk and ultra-high-risk population. Each successful and unsuccessful meeting was summarized and reevaluated using excel reports to enhance future outcomes.
- Managed operational activities including analytical-data reporting for over 800+ Road to Recovery admits, discharges, and follow-ups that covered patient inpatient and outpatient discharges and medication logs.
- Researched and resolved ACHA member complaints. Allocate in-network community resources for reported population such as substance abuse centers, community housing, transportation services, longterm and provider/specialist resources for health plan.
- Provide support on a variety of complex regulations while monitoring polices and implementing new procedures.
Lead Pharmacy Technician
Icore Healthcare/Magellan Health Services
Orlando
05.2013 - 05.2014
- Oversaw performance of work group, including Rx-setup coordinator and pharmacy technician, in processing chemotherapy medical orders, infertility orders, patient therapy home medication orders, and factor orders.
- Completed trainings with other team members on Rx-setup processes, medical billing test claims, and prior authorization approval request.
- Recommended and structured new processes to enhance workflow efficiency and reduce errors.
- Processed and evaluated insurance claims for accuracy and compliance.
- Scheduled staff and collaborated with supervisor in planning departmental work activities.
Intake Customer Care Coordinator
Pharmacy Technician Healthcare Staffing Support
Plantation
10.2011 - 04.2013
- Coordinated intake customer care as pharmacy technician, facilitating scheduling and processing of prescription orders and copayments for patients, medical offices, and health insurance.
- Managed high-volume calls while utilizing multi-tasking skills and operating systems effectively.
- Faxed HIPAA documents and submitted prior authorization requests to ensure timely processing of patient care.
- Processed pay ware system, profiled credit card info, process payments, and billed health insurance using test claims.
- Resolved irate patient's complaints and concerns, improving customer satisfaction and retention.
Education
MBA Degree - Corporate Management, Real Estate & Strategic Negotiation
Florida International University
Miami, FL05-2020
Bachelor of Science - Health Science
Florida A&M University
Tallahassee, FL04-2008
Skills
- Quality assurance
- Compliance Audit
- Compliance Oversight
- Compliance reporting
- Data Reporting
- Project Oversight
- Research and strategy
- Clinical Support
- Medical Records Retrieval
- CSR Software
- TruCare Software
- Five9
- Virtual Observer
- WFM
- Microsoft Office
- Office 365
- PowerPoint
- Training development
- Quality training
- Stakeholder Engagement
- Cross-functional collaboration
- Decision making
- Problem-solving
- Multi-tasking
- Effective communication
- Quality training
Certification
- Rehabilitation Management Services
- Certificate of Completion in Suicide Prevention
- Certificate of Completion in Into to Baker Act
- Certificate of Completion in Six Sigma Awareness
- Certified Real Estate & Negotiations Specialist
- National Board Prior Authorization Certified Specialist
Timeline
Senior Quality Specialist
CareMetx
06.2023 - Current
Sr. Reimbursement Case Manager
CareMetx/ Novartis Pharmaceutical Corporation
09.2020 - Current
Lead Regional Care Coordinator
Magellan Complete Care/ Magellan Health Services
06.2014 - 03.2020
Lead Pharmacy Technician
Icore Healthcare/Magellan Health Services
05.2013 - 05.2014
Intake Customer Care Coordinator
Pharmacy Technician Healthcare Staffing Support
10.2011 - 04.2013
MBA Degree - Corporate Management, Real Estate & Strategic Negotiation
Florida International University
Bachelor of Science - Health Science
Florida A&M University