Summary
Overview
Work History
Education
Skills
Timeline
Generic

Shawanda Mack

Oviedo,FL

Summary

Experienced with eligibility determination, client assessment, and regulatory compliance. Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.

Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level Eligibility position. Ready to help team achieve company goals.

Overview

10
10
years of professional experience

Work History

Claims Representative

Elevate PFS
04.2025 - Current
  • Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
  • Collaborated with internal departments and external vendors to resolve claims.
  • Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.

Clerical Representative

Elevate PFS
10.2021 - 04.2025
  • Contributed to a positive work atmosphere by assisting colleagues with various tasks when needed.
  • Assisted management in making informed decisions by preparing accurate and timely reports.
  • Consistently met deadlines for assigned tasks while maintaining a high level of accuracy in all work completed.
  • Provided exceptional administrative support to senior staff members, allowing them to focus on higher-level responsibilities.
  • Edited documents to keep company materials free of grammar errors.
  • Supported staff on special assignments and ad hoc projects.
  • Compiled and analyzed data to produce reports.
  • Edited and proofread documents for accuracy and completeness.
  • Promptly received and forwarded incoming communications, such as phone calls, emails, and letters, to appropriate staff.
  • Reviewed files, records and other documents to obtain information to respond to requests.
  • Input data into spreadsheets and databases.
  • Developed strong working relationships with clients through excellent communication skills and prompt responses to inquiries or concerns.
  • Reduced errors in data entry tasks, ensuring accuracy and reliability of company records.
  • Collaborated effectively with other departments to ensure seamless workflow processes across the organization.

Clerical Representative

J&K PMS
10.2021 - 04.2025
  • Edited documents to keep company materials free of grammar errors.
  • Edited and proofread documents for accuracy and completeness.
  • Promptly received and forwarded incoming communications, such as phone calls, emails, and letters, to appropriate staff.
  • Reviewed files, records and other documents to obtain information to respond to requests.
  • Input data into spreadsheets and databases.
  • Reduced errors in data entry tasks, ensuring accuracy and reliability of company records.

EBO Specialist

Receivable Solutions
06.2021 - 09.2021
  • Your primary responsibility is to assist patients with their physician &/or hospital bills by extensive telephone contact. This is accomplished by primarily answering inbound patient calls. You will utilize several systems to analyze hospital and physician accounts to determine insurance processing and amounts to be paid by the patient.
  • You will have the opportunity to answer patients' questions regarding statements and insurance coverage in a professional and customer friendly manner. You may also offer patients financial assistance programs as defined by the client.

Insurance Verification Representative

Receivable Solutions
01.2021 - 06.2021
  • Timely processing of initial and ongoing referrals by navigating through established policy and procedures and payer guidelines.
  • Verifies and updates patient demographic and insurance information in the practice management system.
  • Effectively use problem-solving skills to obtain and verify patient demographic and insurance information.
  • Obtains insurance coverage eligibility, benefit verification and accurately determines correct party financially responsible for payment.
  • Obtains necessary authorizations, referrals, or pre certification.

Accounts Receivable Representative

Prisma Health
07.2019 - 04.2020
  • Review past due accounts and prepare for bad debt write off. Contact insurance carriers and patients for immediate payment. Set up payment arrangements according to established guidelines when necessary.
  • Provide duplicate billings, coordination of benefit information and medical records when need to expedite payment of open items. Submit appeals correspondence to third-party payers when claim processed incorrectly. Identify accounts with credit balances and process refund check requests.
  • Monitor claims for appropriate processing.

Medical Collector

Virtual Business Office Associates
03.2015 - 05.2019
  • Contact clients about overdue bills and accounts. This is mainly done via telephone contact; however, use of the postal system may be required if there are no telephone numbers available for the client.
  • Collect payments on the overdue bills.
  • Offer lower interest payments, payment assistance or create individually tailored payment plans unique to a person's financial situation in order to facilitate payment.
  • The collector notes the payment agreement and passes it on to his or her supervisor. However, if the client refuses to pay or refuses to answer communication attempts, the medical collector can resort to repossessing, wage garnishing or involving legal authorities.

Customer Service Advocate

Blue Cross Blue Shield
11.2015 - 03.2016
  • Answer inbound calls and address customer inquiries pertaining to the specific product
  • Field a diverse variety of questions for a diverse group of accounts
  • Assist customers via phone with both internal and external inquiries
  • Responsible for delivering quality and outstanding customer service to customers while maintaining call center department guidelines
  • Perform product retention/stop save during cancellation calls.
  • Resolve all issues and offer additional services by utilizing our cross-sell program
  • Responsible for determining and resolving customers’ needs
  • Update customers’ account information in the system
  • Ensure customers’ needs are met following department procedures, standards and external regulations
  • Ensure adherence to federal, state and local laws and regulations

Education

Associates in Arts - undefined

South Carolina State University
12.2009

Bachelor's - Psychology

Calhoun Technical College
05.2008

Skills

  • Customer Service
  • Call Center
  • Medical Collection
  • Medical Terminology
  • Planograms
  • Insurance Verification
  • Insurance Sales
  • Computer Literacy
  • Accounts Receivable
  • Document management
  • Proofreading expertise
  • Positive attitude
  • Customer service
  • Verbal and written communication
  • Data entry
  • Medical terminology
  • Excel spreadsheets
  • Microsoft office
  • Resource information
  • Medicaid
  • Eligibility procedures
  • Income verification
  • Teamwork
  • Active listening
  • Computer proficiency
  • Documentation skills
  • Eligibility determination
  • Payment collection

Timeline

Claims Representative

Elevate PFS
04.2025 - Current

Clerical Representative

Elevate PFS
10.2021 - 04.2025

Clerical Representative

J&K PMS
10.2021 - 04.2025

EBO Specialist

Receivable Solutions
06.2021 - 09.2021

Insurance Verification Representative

Receivable Solutions
01.2021 - 06.2021

Accounts Receivable Representative

Prisma Health
07.2019 - 04.2020

Customer Service Advocate

Blue Cross Blue Shield
11.2015 - 03.2016

Medical Collector

Virtual Business Office Associates
03.2015 - 05.2019

Associates in Arts - undefined

South Carolina State University

Bachelor's - Psychology

Calhoun Technical College

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