Shawna Holly
Summary
Seasoned collaborator experienced in meeting needs, improving processes and exceeding requirements in team environments. Diligent worker with strong communication and task prioritization skills.
Overview
11
11
years of professional experience
Work History
Business Analyst
Prime Therapeutics LLC
12.2022 - Current
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Developed high-quality documentation to support training efforts, helping employees fully understand new systems and procedures.
- Performed gap analysis between existing systems or processes and desired state, identifying areas for improvement or enhancement.
- Improved business processes by analyzing current practices and recommending optimization strategies.
- Interacted with internal customers to understand business needs and translate into requirements and project scope.
- Collaborated closely with stakeholders to identify opportunities for process improvements and drive continuous innovation in the organization.
- Supported software development projects by defining clear requirements and effectively communicating them to technical teams.
Business Analyst
Magellan Health
06.2022 - 12.2022
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Developed high-quality documentation to support training efforts, helping employees fully understand new systems and procedures.
- Improved business processes by analyzing current practices and recommending optimization strategies.
- Interacted with internal customers to understand business needs and translate into requirements and project scope.
- Supported software development projects by defining clear requirements and effectively communicating them to technical teams.
- Drove operational efficiency by automating routine tasks, freeing up staff to focus on more complex issues.
Utilization Management Representative
Magellan Health
12.2019 - 06.2022
- Increased overall efficiency by streamlining authorization processes for medical procedures.
- Developed strong working relationships with healthcare providers to ensure seamless communication and coordination of services.
- Ensured proper documentation and coding of medical treatments, enhancing billing accuracy and reimbursement rates.
- Promoted a culture of collaboration and teamwork, fostering an environment that encouraged open communication and shared learning among colleagues.
- Served as a liaison between patients, healthcare providers, and insurance companies to facilitate timely approvals of necessary treatments.
Medical Billing Specialist
Mitchell International, Inc.
08.2017 - 12.2019
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Posted and adjusted payments from insurance companies.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Located errors and promptly refiled rejected claims.
- Enhanced revenue collection through diligent follow-up on unpaid claims and denials with insurance companies.
Member Service Representative II
Molina Healthcare
01.2016 - 08.2017
- Benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs))
- Verified customer identification and documentation for compliant transactions.
- Promoted a positive work environment by fostering open communication between colleagues and supervisors.
- Review and research incoming healthcare claims from members and providers(doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing
- Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding
- Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Provided exceptional service through active listening, understanding member needs, and offering appropriate solutions.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
- Maintained high-quality service by adhering to company policies and standards in all member interactions.
Front End Cashier/Customer Service
Walmart Stores Inc.
01.2016 - 12.2016
- Received payments via cash, debit/credit card
- Issued receipts, credits, change as needed
- Greet all clientele
- Maintained clean work area at all times
- Provide reassurance and encouragement during sporting events and during training
Medical Billing Specialist I
Clarient Diagnostics (GE Healthcare)
01.2014 - 12.2015
- Maintained data entry requirements by following data program techniques and procedures
- Maintain customer confidence and protects operations by keeping information confidential
- Research necessary patient billing documents within HIPPA regulations
- Prepared and submitted clean claims to various insurance companies electronically/paper claims
- Identified and resolved patient billing complaints
- Assisted medical coder in billing the proper ICD-9/10 codes
- Prepared and reviewed patient statements
- Complied team data and lead daily team meetings
- Complied data reports for data entry errors and processes
- Verified patient data by reviewing and inputting electronic data information from XIFIN and Workflow
- Participated in education activities and attended monthly staff meetings
- Electronic sorting of requisition forms
- Assisted in training of new hires
Education
Certified Phlebotomy Tech -
National Certification
01.2016
General Studies - emphasis in Nursing
Long Beach City College
01.2005
Medical Assistant Diploma -
NIT Bryman College
01.2003
Diploma -
Artesia High School
01.1998
Skills
- Customer Service
- Team Collaboration
- Information/Insurance Verification
- Administrative Support
- Problem Solving
- Requirements Gathering
- Microsoft Office Suite
- HIPPA Compliance
- Blood Draws
- Knowledge of Medical Terminology
- Data management
- Process Optimization
Course Related Skills
- Customer Service
- Data Entry/Accuracy
- Team Collaboration
- Information/Insurance Verification
- Administrative Support
- Sorting/Mail Processing
- Problem Solving
- Product Knowledge
- Typing 65 wpm
- Medical Billing
- HIPPA Compliance
- Blood Draws
- Knowledge of Medical Terminology
Languages
English
Native or Bilingual
Timeline
Business Analyst
Prime Therapeutics LLC
12.2022 - Current
Business Analyst
Magellan Health
06.2022 - 12.2022
Utilization Management Representative
Magellan Health
12.2019 - 06.2022
Medical Billing Specialist
Mitchell International, Inc.
08.2017 - 12.2019
Member Service Representative II
Molina Healthcare
01.2016 - 08.2017
Front End Cashier/Customer Service
Walmart Stores Inc.
01.2016 - 12.2016
Medical Billing Specialist I
Clarient Diagnostics (GE Healthcare)
01.2014 - 12.2015
General Studies - emphasis in Nursing
Long Beach City College
Medical Assistant Diploma -
NIT Bryman College
Diploma -
Artesia High School
Certified Phlebotomy Tech -
National Certification
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