Shashani Jones
The Bronx,NY
Summary
Dedicated administrative professional with years of successful experience in fast-paced office and hospital settings. Hardworking team player with expertise in completing various clerical tasks and offering staff support. Responsible, punctual and productive professional when working with little to no supervision. Over 20 years of customer service and claims experience. Knowledgeable and dedicated customer service professional with extensive experience in managed care industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
19
19
years of professional experience
Work History
Desk Clerk
Bowery Residents Committee
01.2023 - Current
- Greeted visitors and customers upon arrival, offered assistance, and answered questions to build rapport and retention.
- Supported staff with clerical assistance for diverse daily routines and special actions.
- Recorded significant occurrences in daily log with professionalism and critical details.
- Monitored building for hazardous conditions or situations and notified correct personnel.
- Assisted with onboarding of new employees.
Contact Tracer/ Cross Monitor
NYC Test & Trace Corps.
12.2020 - 12.2021
- Investigated and identified confirmed and suspected coronavirus cases, also documenting potentially affected contacts.
- Communicated with documented COVID-19 patients and other exposed persons via phone call, text, e-mail and other platforms.
- Provided educational and informational resources regarding isolation policies and quarantine measures.
- Lent daily assessment of health screen and symptom data.
- Participated in health promotion campaigns to raise awareness of health issues.
- Notified and interviewed individuals to ascertain novel coronavirus exposure level.
- Performed record keeping by logging client information within secure contact-tracing software.
Customer Service Representative II
Metroplus HealthPlan
04.2010 - 02.2021
- Provided primary customer support to internal and external customers.
- Responded to customer requests for products, services, and company information.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Answered constant flow of customer calls with minimal wait times.
- Updated account information to maintain customer records.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Clarified customer issues and determined root cause of problems to resolve product or service complaints.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Cross-trained and provided backup support for organizational leadership.
- Investigated and resolved customer inquiries and complaints quickly.
- Collaborated with internal departments and external vendors to achieve fast resolution of claims.
- Prepared and presented detailed reports to management on claims issues to aid in decision making.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Collected premiums and issued accurate receipts.
- Educated customers about billing, payment processing and support policies and procedures.
- Analyzed and addressed escalated claims to resolve issues quickly.
Unit Secretary/Clerk
Montefiore Medical Center: Jack D. Weiler Hospital
02.2005 - 11.2014
- Maintained current and accurate medical records for patients.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Processed lab paperwork and requests according to physicians' orders.
- Enhanced office productivity by handling high volume of callers per day.
- Provided information for patient admissions and discharges to foster timely processing.
- Maintained rapport with physicians, nurse,s and other healthcare personnel.
Utilization Reviewer /Medical Claims Coordinator
NY Presbyterian Community Health Plan
New York, NY
01.2005 - 10.2009
- Provided backup to front desk to step in to assist with various tasks whenever employee was absent or at lunch.
- Reviewed provider coding information to report services and verify correctness.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Responded to correspondence from insurance companies.
- Processed insurance payments and maintained accurate documentation of payments.
- Identified and resolved discrepancies between patient information and claims data.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Monitored and updated claims status in claims processing system.
- Followed up on denied claims to verify timely patient payment and resolution.
- Input data into computer programs and filing systems.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Delegated tasks to administrative support staff to organize and improve office efficiency.
- Paid or denied medical claims based upon established claims processing criteria.
Education
Bachelor of Science - Criminal Justice
Monroe College
The Bronx, NY05.2008
Skills
- Problem-Solving Skills
- Government Forms
- Customer Satisfaction
- Customer Support Needs Assessment
- Multitasking Abilities
- Good Telephone Etiquette
- Teamwork and Collaboration
- Critical Thinking
- Crisis Communications
- Credit Card Transaction Processing
- NYC Certified Clerical Associate
Additional Information
Types 70 WPM, 10,000 Keystrokes per min.
Computer skills with Mysis, Epaces, Royal Healthcare Systems, Med-Decision, CIS, InterQual, NYS DOH, MHS Systems.Reflections, E-Mev, Or Scheduling Manager. Txen, Tele-Tracking system,Epic,EMR.
Timeline
Desk Clerk
Bowery Residents Committee
01.2023 - Current
Contact Tracer/ Cross Monitor
NYC Test & Trace Corps.
12.2020 - 12.2021
Customer Service Representative II
Metroplus HealthPlan
04.2010 - 02.2021
Unit Secretary/Clerk
Montefiore Medical Center: Jack D. Weiler Hospital
02.2005 - 11.2014
Utilization Reviewer /Medical Claims Coordinator
NY Presbyterian Community Health Plan
01.2005 - 10.2009
Bachelor of Science - Criminal Justice
Monroe College
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