Sharmekia May
Baton Rouge,LA
Summary
Dedicated and knowledgeable Customer Service Representative 20 years of customer service experience and w 4 years of extensive experience in Medicaid coverage, CPT/ICD coding, and healthcare prior authorizations. Adept at navigating complex case management systems and translating healthcare terminology into clear, reassuring language for members and providers. Proven track record of delivering patient-centered support, maintaining HIPAA compliance, and collaborating cross-functionally with clinical teams. Recognized for empathy, accuracy, and a calm demeanor—even in high-volume, high-pressure environments.
Overview
6
6
years of professional experience
Work History
Customer Service Representative
Acentra Health
10.2021 - Current
- Guided providers through the submission and review of prior authorization requests, ensuring proper coding (CPT/ICD) and required clinical documentation.
- Provided expert-level phone support to Medicaid beneficiaries and providers, clarifying benefit coverage, eligibility, and service guidelines.
- Collaborated with nurses and medical review teams to resolve escalated cases and ensure timely patient care decisions.
- Updated and tracked cases in proprietary CMS tools while maintaining strict HIPAA standards.
- Helped onboard and mentor new team members on system tools, policy navigation, and patient-centered service techniques.
- Recognized for excellent call quality, minimal error rate, and consistently positive member feedback.
Customer Service Representative
EQ Health Solutions
04.2021 - 10.2021
- Assisted providers with prior authorization requests for procedures, diagnostics, and medications, ensuring all required clinical documentation and CPT codes were correctly submitted and processed.
- Delivered empathetic, accurate support to patients, providers, and healthcare professionals regarding Medicaid-covered services, benefits eligibility, and coverage details.
- Interpreted and explained CPT and ICD-10 codes to both medical professionals and non-clinical callers, helping ensure clarity and compliance with Medicaid guidelines.
- Maintained up-to-date knowledge of changing Medicaid rules and prior authorization policies across multiple states, ensuring timely and compliant responses.
- Used eQHealth’s case management and authorization platforms to review case status, update records, and document all calls accurately while maintaining strict confidentiality (HIPAA compliance).
- Provided technical assistance and training to new team members on Medicaid workflows, system navigation, and customer service standards.
Customer Service Representative
Cox Communications
06.2019 - 01.2021
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
- Assisted customers in navigating the company website and placing online orders, improving the overall user experience.
Education
Bachelor of Science - Psychology
Colorado Technical University
Colorado Springs, CO06.2026
Certificate - Medical Assistant
Remington College
Baton Rouge, LA10.2011
Skills
- Medicaid Policy & Coverage
- CPT/ICD-10 Code Knowledge
- Prior Authorization Processing
- Case Management Software (CMS)
- HIPAA & Confidentiality
- Provider & Member Communication
- Call De-escalation
- Team Mentorship & Support
- Critical thinking
Timeline
Customer Service Representative
Acentra Health
10.2021 - Current
Customer Service Representative
EQ Health Solutions
04.2021 - 10.2021
Customer Service Representative
Cox Communications
06.2019 - 01.2021
Bachelor of Science - Psychology
Colorado Technical University
Certificate - Medical Assistant
Remington College
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