Sharon Bailey
Oviedo,FL
Summary
A highly organized and meticulous individual with years of experience in diverse setting including corporate, school, and non-profit organization setting. High level of education, and effective communicator. Results-driven professional with comprehensive background in appeals processes and case management. History of implementing strategies to resolve disputes and ensure compliance. Strong focus on collaborative teamwork and delivering reliable solutions, adaptable to dynamic environments.
Overview
19
19
years of professional experience
Work History
Senior Appeal Specialist
Express Scripts/Cigna
10.2023 - Current
- Conduct a thorough examination and analysis of rejected claims to identify the underlying reasons for denial and evaluate the likelihood of a successful appeal.
- Prepare and submit written appeals to insurance companies, including gathering necessary documentation and evidence to support the appeal.
- Interpret and apply current healthcare regulations, payer policies, and coding guidelines to ensure compliance with the appeals process.
- Developed customized appeal letters tailored to each case''s unique circumstances, increasing the likelihood of successful outcomes.
- Ensure timely follow-up and resolution by monitoring and tracking the status of submitted appeals.
- Facilitate peer-to-peer reviews between healthcare providers and insurance company medical reviewers when required.
- Reduced processing errors by meticulously reviewing claim documentation and ensuring adherence to company policies and guidelines.
Prior Authorization Representative
Cigna Express Scripts
09.2021 - 10.2023
- Reviewed requests from medical and pharmacy staff.
- Improved patient satisfaction by efficiently processing prior authorization requests and ensuring timely responses.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Facilitate resolution of drug coverage issues and pro-actively address, research and resolve issues while maintaining accurate documentation of all inquiries for continuous improvement.
- Worked collaboratively with other associates and supervisors to ensure best practices.
- Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
Vaccination Specialist: Temporary
Apple one/FDOH
01.2021 - 05.2021
- Worked with the State of Florida COVID-19 system to register clients and schedule their vaccination.
- Ability to work with changes and constant update to the state mandates.
- Ability to educate customers concerning COVID-19 questions.
Manager of Operations
BSN Dynamic Home and Commercial Improvement
01.2006 - 01.2020
- Provided management and vision necessary to ensure that the company has the proper operational controls, administrative and reporting procedures.
- Provided day-to-day leadership and management to a service organization that mirrors the adopted mission and core values of the company.
- Worked with banks and real-estate companies concerning bank and privately owned in restoration of property.
- Ensured compliance with industry regulations, maintaining a safe working environment for staff members.
- Negotiated favorable contracts with vendors, securing competitive pricing arrangements that benefited the organization''s bottom line results.
President
The True Vine Community Organization, Inc
01.2007 - 01.2017
- Supervised volunteers’ and staff participation which includes scheduling and support other administrative staff for community programs.
- Conduct weekly educational program that designed for improvement of conducting and teaching at all levels.
- Life learning lessons, which provides advice, support, practical help and best practice guidance on all aspects for life improvement.
- Worked with community churches in food distribution and assisting in homeless program.
- Enhanced company performance by implementing strategic plans and overseeing daily operations.
Education
Doctor of Education (Ed.D) - Organizational Leadership with Emphasis in Behavioral Health
Grand Canyon University
Phoenix, AZ08-2024
MBA -
University of Phoenix
Tempe, AZ05.2008
Bachelor of Arts - Psychology/Counseling Human Growth And Development
Sojourner Douglass College
Baltimore, MD06.2006
Certificate - Chemistry
UNIVERSITY OF LONDON
01.1987
Skills
- Leadership
- Critical Thinker
- Computer Proficiency
- Case Management
- Problem Solving and Time Management
- Interpersonal Skills
- Data/Statistical Analysis
- Reliability
- Active Listening
Accomplishments
- The Department of Homeland Security Presentation for Black History Month. Guest Speaker.
- Published Academic Manuscript.
Training
- Certified Geriatric Nursing
- Tax Preparation
- Addition Counseling (Intern)
- HIV/AIDS Counseling (Intern)
Leadership Experience
03/01/19, 04/01/21- Parent-Representative, 4C Florida (Community Coordinated Care for Children),
- Report Policy Council activities., Attended Policy Council meetings. Served as a link to Head Start, Early Head Start, and the community.
07/01/23, 09/01/23,Member, Express Scripts (Quality Counsel Committee),
- Examined and researched trends pertaining to quality issues., Gathered data from the past quarter, filtered for missed audit issues and root causes., Analyzed prevailing patterns and devise effective solutions to address quality deficiencies within the CRD team.
Timeline
Senior Appeal Specialist
Express Scripts/Cigna
10.2023 - Current
Prior Authorization Representative
Cigna Express Scripts
09.2021 - 10.2023
Vaccination Specialist: Temporary
Apple one/FDOH
01.2021 - 05.2021
President
The True Vine Community Organization, Inc
01.2007 - 01.2017
Manager of Operations
BSN Dynamic Home and Commercial Improvement
01.2006 - 01.2020
Doctor of Education (Ed.D) - Organizational Leadership with Emphasis in Behavioral Health
Grand Canyon University
MBA -
University of Phoenix
Bachelor of Arts - Psychology/Counseling Human Growth And Development
Sojourner Douglass College
Certificate - Chemistry
UNIVERSITY OF LONDON
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