Sharon Waldron

• Maintained accurate documentation on 20 cases, ensuring compliance with regulations and confidentiality requirements.
• Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
• Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
• Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.

• Resolved customer service issues by finding immediate solutions, increasing customer confidence, and decreasing escalations to executive office.
• Enhanced team productivity by 20 percent implementing efficient workflow processes and setting clear performance expectations.
• Led 35 employee through effective communication, coaching, training, and development.
• Collaborated with senior management on strategic planning efforts, aligning departmental objectives with overall company vision.
• Conducted regular performance reviews, providing constructive feedback and coaching to facilitate continuous improvement among employees.
• Established a culture of accountability within the team, resulting in higher levels of individual responsibility towards achieving organizational goals.
• Consistently met or exceeded departmental goals of 1500 cases by effectively managing resources and establishing clear objectives for the team.

• Enhanced communication between clients and providers through consistent follow-ups and progress updates of 25 or more cases per day.
• Achieved positive client outcomes by developing and implementing comprehensive case management plans.
• Advocated for client rights when interacting with external agencies or institutions, ensuring fair treatment at all times.
• Provided crisis intervention support for clients experiencing emergencies, using appropriate techniques to de-escalate situations safely.
• Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.

• Performed visual inspections and non-destructive tests on 30 cases per day.
• Reported repeated issues to supervisors and other departments, collaborating to identify issue roots and rectify problems.
• Communicated with production team members about quality issues.
• Used calipers and micrometer measuring instruments.
• Maintained accurate records of inspection findings, facilitating data-driven decision-making for process improvements.
• Kept detailed records of quality and imperfect products.
• Influenced positive change within the organization by driving a culture focused on high-quality products and services.
• Conducted training sessions for new Quality Assurance Inspectors, ensuring a consistent approach across the team.

• Led and coordinated multiple fraud and claims projects by completing and updating project documentation, managing project scope, determining daily priorities, and ensuring efficient and on-time delivery of project tasks and milestones, resulting in projects being completed on time.
• Worked with Class Action/Remediation Department • Responsible for escalating problem accounts through the proper escalation paths to settle accounts with a higher level of complexity, which streamlines fraud and claims processes.
• Managed approximately 30 calls emails per day

• Coordinated customer relationships providing prompt and specific solutions to our clients’ needs, increasing customer service productivity.

• Managed business risk by following all guidelines and procedures, ensuring policy updates were incorporated into the daily tasks.

• Proven ability to learn quickly and adapt to new situations.

• Trained, directed, and managed the patient service team with processing 40 billing escalations to the appropriate lead and business unit to maintain a productive workflow.

• Responsible for the teaching and coaching of patients and caregivers on the healthcare online portals and financial aid programs, ensuring clients receive information on healthcare options and benefits.

• Applied a consistent fundamental understanding of Medicaid and Medicare to the daily billing functions to accurately submit claims and process billing.

• Utilized and extensive knowledge of community services and resources to refer patients to the appropriate organizations, resulting in patients receiving healthcare assistance.

• Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.

• Conducted quality assurance analysis of healthcare plans across a multi-system platform to check for accuracy and to identify and correct variances.
• Responsible for validating 5 all changes requested by sales management to ensure specified changes were applied to patient benefits.
• Collaborated with internal departments to research and resolve 30 benefits issues during the Benefit Summary Creation Life Cycle Project.
• Utilized multiple web-based resources to review benefits for Federal Regulation and State Mandate compliance, as well as Client product standards.
• Executed an early enrollment plan to reduce medication costs for patients who may experience financial hardship.

• Delivered exceptional customer service, managing 45 routine questions and resolving service complaints.
• Trained and motivated team members to strengthen customer service strategies, increasing our satisfaction rating.
• Managed GMC White Collar Navigation services and partnered with outside agencies Red Cross and FEMA to evacuate customers during disastrous weather.
• Delivered exceptional customer service, managing routine questions and resolving service complaints and requests.

• Ensured the accuracy and completeness of benefits applications and conducted non-clinical reviews based on applicable criteria and guidelines on requested services. Communicated decisions to the provider and/or member, according to department protocols.

• Documented accurate and thorough outcomes of reviews, which demonstrated the ability to interpret and analyze the nonclinical information. • Reviewed and processed employee enrollments to verify accuracy, executing data management procedures of inputting information into the company database for maintenance and storage.

• Supports the Centers for Medicare & Medicaid Services (CMS) requirement for soliciting information or notification standards.

• Complied with company and insurance client's guidelines in claims processes, estimate writing, and closing of claims, resulting in 500,000 per day

• Spearheaded simplification initiatives and operational strategies to improve the collections process to drive customer satisfaction.

• Assisted in audit preparation, providing necessary documentation for thorough review of financial activities.
• Prepared detailed reports on account activity for management review, identifying areas for improvement or concern.