Summary
Overview
Work History
Education
Skills
Timeline
Generic

Shawn Kari Martinez

Medford,NY

Summary

Strong customer service background , high level of professionalism,patience and efficiency to minimize dissatisfaction. Successful at efficiently handling client inquiries, billing and administrative tasks. Familiar with contracts and other documents affecting billing processes. Prepares professional, polished statements and business correspondence.

Overview

17
17
years of professional experience

Work History

Billing Specialist

Suncoast Surgical Associates
Brandon, FL
01.2018 - Current
  • Prepare grievance and appeals to Aetna for underpayment disputes.
  • Negotiate agreements with third party payers.
  • Handle high volume of calls regarding patient billing questions.
  • Process patient payments.
  • Evaluate Explanation of Benefits to determine if Insurance Company processed claim correctly.
  • Process weekly Accounts Receivable Reports.
  • Review and initiate open negotiations with Aetna due to 2022 No Surprise Act.

Call Center Representative

Stony Brook Medicine
10.2022 - Current
  • Scheduling high volume of appointments for 6 different specialists
  • Obtain, verify and input all information accurately into scheduling system.
  • Provide customer service to patients.
  • Demonstrate courteous and professional behavior when dealing with patients.
  • Resolve patient inquiries or escalate for resolution.
  • Routing calls to proper departments

Team Facilitator

EmblemHealth
Melville, NY
08.2007 - 05.2017
  • Call Center leader that routinely utilized my extensive skills and knowledge gained through my previous call center experience and training. Provided administrative and clerical support to the Department Supervisor as a partner in the daily monitoring of the ACD to ensure skills were set to meet corporate goals and to ensure customer satisfaction. Maintained record of adherence exceptions and report daily to the Department Supervisor.
  • Assisted Co-workers in developing their skills and knowledge; shared information to help them successfully serve the customer on a daily basis. Encouraged continuous learning by assisting the staff in determining the appropriate solution with questions about claims, benefits, enrollment, billing and administrative items.
  • I was responsible for bringing closure for member and provider issues,which required research and written or verbal response,this required handling complicated issues and irate members and providers. I handled escalated telephone callers and took all steps needed to bring the issue to closure. I assisted the Medical Management Department by setting up authorizations for medical and dental procedures.

Education

Associate of Applied Science - Travel And Tourism

Suffolk County Community College
Riverhead, NY
05.1996

Skills

    • High customer service standards
    • Customer service management expertise
    • Negotiation competency
      • Conflict resolution proficiency
      • Troubleshooting skills

Timeline

Call Center Representative

Stony Brook Medicine
10.2022 - Current

Billing Specialist

Suncoast Surgical Associates
01.2018 - Current

Team Facilitator

EmblemHealth
08.2007 - 05.2017

Associate of Applied Science - Travel And Tourism

Suffolk County Community College

Similar Profiles

CREATE PROFILE
Shawn Kari Martinez