Shateana Edwards
Wickliffe,OH
Summary
- Customer Service Skills
- Patient Care Skills
- Proficient computer skills with Microsoft Office Programs
- Highly motivated
- Good communication skills
- Time management skills
- Self-motivated and able to work independently
- Experience working remotely
- Healthcare experience
- Health insurance experience
Dependable Patient Financial Advocate serving diverse needs of patients through active communication and responsive engagement with healthcare services and policymakers. Skilled at analyzing case files and databases to speed up inquiry response times and guide information through appropriate personnel channels. Maintains highest standards of ethics, professionalism, and regulatory compliance to ease common stressors and de-escalate potential conflicts.
Overview
13
13
years of professional experience
Work History
Patient Financial Advocate
Cleveland Clinic
07.2023 - Current
- Counseling patients and parties responsible for payment regarding insurance benefits, services received, payment options, collection procedures and financial assistance
- Acting as an advocate for patients
- Contacting insurance carriers
- Performing in a professional, caring and helpful manner when collecting payments from patients
- Working out of a workque under minimal supervision
- Improved patient financial experiences by providing comprehensive guidance on payment options and assistance programs.
- Strengthened relationships with insurance companies through effective communication and collaboration, resolving billing disputes efficiently.
- Increased revenue collections by conducting thorough reviews of patient accounts and identifying potential sources of reimbursement.
- Streamlined the application process for financial aid, reducing wait times and increasing patient satisfaction.
- Assisted patients in understanding insurance coverage, resulting in informed decisions regarding medical services.
- Simplified complex financial information for patients, empowering them to make informed choices about their healthcare expenses.
- Receiving calls from departments to educate on department specifics for payment
- Has excellent multi-tasking, critical thinking and problem-solving skills
- Easily adapts to change.
Provider Customer Service Representative
CVS Aetna
01.2020 - 07.2023
- Following HIPPA guidelines effectively validating providers and members, accessing and quoting provider contracts
- Following policy and procedures required by CVS Aetna, while accessing members' benefits being the liaison between Aetna and providers giving exceptional customer service
- Provide providers with member benefits and eligibility also checking CPT Codes, ICD-9-CM, and ICD-10-CM codes to ensure pre-certification is required and exceptions on codes, checking appeals statuses
- Navigating multiple plan types to validate if benefits require referrals for member plans such as HMO plans, POS, AND PPO plans
- Working on multiple screens on multiple systems
- Researching claims, providing claims status and researching why claims are not approved by the insurance company, checking clinical coding database and Rule IDs on claims with systems such as McKesson
- Quickly and effectively working through multiple systems
- Initiating reprocessing of claims for physicians and hospitals
- Proper documentation of all calls received inbound and outbound
- Navigating and initiating appeals sent by providers and explaining the status of appeals status and final determination.
Medical Assistant
Cleveland Clinic Internal Medicine
08.2011 - 01.2020
- Reviewed and assisted with updating accurate documentation of patient's health history and medications
- Assisted with creating physician schedules and ensuring physicians remained punctual
- Collaborated with other medical assistants to ensure each physician had the proper space to practice
- Obtained prior authorization from insurance companies and ensured that services rendered were covered by patient's insurance
- Assisted with managing physician phone calls, emails, and medication requests and punctual responses to patients
- Compiled and prepared detailed schedules for medical assistants
- Assisted with scheduling and canceling patients via Epic electronic medical records system
- Consistently exceeded great patient service and problem-solving and resolving situations with displeased patients
- Training new employees on policies, procedures, and company guidelines.
Education
Revenue Cycle Management Certificate of Achievement -
Internship Cleveland Clinic Revenue Cycle Management
08.2023
Cuyahoga Community College
Cleveland, Ohio05.2023
Medical Billing and Coding Certification -
Cleveland Institute of Dental And Medical Assisting
05.2023
Associate in Applied Business Degree -
Lakeland Community College
Kirtland, Ohio05.2019
Skills
- Policy Understanding
- Financial Counseling
- Active listening
- Team collaboration
Timeline
Patient Financial Advocate
Cleveland Clinic
07.2023 - Current
Provider Customer Service Representative
CVS Aetna
01.2020 - 07.2023
Medical Assistant
Cleveland Clinic Internal Medicine
08.2011 - 01.2020
Revenue Cycle Management Certificate of Achievement -
Internship Cleveland Clinic Revenue Cycle Management
Cuyahoga Community College
Medical Billing and Coding Certification -
Cleveland Institute of Dental And Medical Assisting
Associate in Applied Business Degree -
Lakeland Community College
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