SHAWNA ROGERS
TUSCOLA,IL
Summary
Experienced intake coordinator with over 10 years of expertise in data entry, client communications, and administrative support within the healthcare and insurance industries. Successfully manages inbound calls, emails, voicemails, and systems to efficiently handle client inquiries, process medical records, and provide timely responses. Proficient in computer programs and navigating health insurance systems, coordinating benefit decisions, and providing essential network information to clients and healthcare professionals/vendors. Adept in expediting email processes, training new staff, and ensuring smooth operations through accurate data management and medical management protocols. Known for strong organizational skills, attention to detail, and ability to work under pressure while maintaining a high level of customer service and professionalism. Professional management specialist with proven skills in coordination, strategic planning, and process optimization. Strong emphasis on team collaboration and achieving results in fast-paced environments. Expertise in project management, communication, and problem-solving. Reliable and adaptable, consistently meeting changing organizational needs with precision and efficiency.
Overview
15
15
years of professional experience
1
1
Certification
Work History
MEDICAL MANAGEMENT COORDINATOR
HEALTH ALLIANCE MEDICAL PLANS
Tuscola , IL
01.2014 - Current
- Client interaction and communication
- Overseeing processes, coordinating care, managing patient data, vendor information, provider clinical and EMR data
- Data entry, documentation, claims, prior authorizations medical protocol and InterQual criteria
- Processing and dispute resolution
- Health insurance benefit and network coordination and medical management
- Collaboration with health care providers and clients
- Assisted with training and on boarding new intake coordinators in medical management and customer support
- Built customer service cheat sheets and assisted with written processes and department procedures
- Ability to evaluate clinical documentation for compliance and accuracy
- Organization skills , ability to manage multiple staff and tasks in fast paced environment
- Effected communication and collaboration with internal and external stake holders, providers, members, client services, sales, vendors, vendor coordinators and case management
- Proficiency in Microsoft office and department specific applications
- Email expeditions and process optimization
- Proactive problem solving , issue resolution
- Administrative support for clients and staff
- Perform detailed reviews of medial prior authorizations establishing medical criteria and clinical guidelines
- Validate medical necessity, appropriateness of care and adherence to program exclusions, limitations and benefits
- Collaborate with RN and medical directors, providers, and claims teams to resolve coding or clinical questions
- Prepare claims for payment review or escalate to medical director and nursing staff if necessary
- Identify and report potential quality and or fraud issues to management and relevant departments (compliance, special investigations unit)
- Review claims data to recommend process improvements and support accurate claims payment
- Ensure compliance with contract timelines for claims resolution
- Maintain consistent production standards and meet processing quotas
- Increased overall efficiency with meticulous organization, scheduling, and resource allocation.
- Conducted thorough risk assessments before embarking on any new venture or investment ensuring proper due diligence was completed and potential obstacles were anticipated.
- Reduced departmental expenses significantly by identifying cost-saving opportunities without compromising quality or performance.
- Enhanced customer satisfaction levels by addressing concerns promptly and implementing tailored solutions.
- Managed key stakeholder relationships to ensure positive outcomes for projects while maintaining open lines of communication between all parties involved in decision-making process.
- Delivered top-notch results consistently by aligning objectives with organizational goals, setting clear expectations, and measuring performance regularly.
- Managed multiple high-priority projects simultaneously ensuring deadlines were met without compromising quality standards.
- Assisted in on boarding, training mentorship, and coaching sessions which resulted in increased capabilities and overall effectiveness.
- Implemented innovative marketing campaigns for enhanced brand visibility and market share growth.
- Developed high-performing teams through focused recruitment efforts and targeted staff development initiatives.
- Successfully negotiated contracts with vendors for cost-effective services while maintaining strong professional partnerships.
- Improved team productivity by promoting collaboration, training opportunities, and ongoing communication.
- Built lasting relationships with clients through exceptional service delivery combined with deep understanding of their unique needs resulting in increased repeat business rates.
- Optimized workflows to drive increased efficiency across all departments by analyzing processes and recommending improvements.
Hacs - Customer Services Client Support Rep2
Health Alliance Medical Plans
12.2011 - 01.2013
- Collaborated with team members to ensure seamless communication and consistent service delivery.
- Contributed to process improvements by sharing feedback from customer interactions with management teams.
- Streamlined service processes for quicker response times, leading to improved customer experiences.
- Fostered a positive work environment by actively participating in team-building activities and promoting open communication between colleagues.
- Email Expeditions and process optimization
- Problem Solving & Issue Resolution, Claims Counts, Network and Benefit coordination
- Administrative Support for clients, healthcare providers, medical management, nursing staff and vendors
- Perform detailed reviews of medical claims using established clinical criteria and guidelines (e.g., CDST, CPT, HCPCS, ICD-10).
- Validate medical necessity, appropriateness of care, and adherence to program exclusions, limitations, and benefits.
- Collaborate with medical directors, providers, and claims teams to resolve coding or clinical questions.
- Prepare claims for payment review or escalate to medical director if necessary.
- Identify and report potential quality or fraud issues to management and relevant departments (e.g., Quality Management, Program Integrity).
- Review claims data to recommend process improvements and support accurate claims payment.
- Ensure compliance with contract timelines for claims resolution.
- Maintain consistent production standards and meet processing quotas.
- Communicate effectively across teams to support operational excellence.
SITE SECURITY OFFICER
CARLE FOUNDATION HOSPITAL
01.2010 - 01.2011
- Access control to records, EMR, patient Database, and building security systems both physical and cyber.
- Security systems monitoring, reporting, incident response, report writing, customer service, conflict resolution, emergency preparedness,
- Hourly Vehicle and property inspections
- Training and mentorship
- Addressed potential risks by regularly reviewing and updating site-specific security plans according to changing conditions.
- Enhanced site security by conducting thorough patrols and identifying potential vulnerabilities.
- Reduced security incidents by implementing effective access control measures for all visitors and employees.
- Assisted in the development of contingency plans for various emergency scenarios, ensuring preparedness and resilience in times of crisis.
Education
Bachelor of Science - Applied Sciences
EASTERN ILLINOIS UNIVERSITY
Charleston, IL01.2012
Associate of Applied Science - Criminal Justice- Appliced Sciences
PARKLAND COLLEGE
Champaign Illinois01.2010
Highschool -
HERITAGE HIGHSCHOOL
Broadlands Illinois01.2007
Skills
- Critical thinking, Communications, Organizational skills, Data Entry and management
- Medical terminology
- Outpatient/ inpatient utilization &Skilled nursing coordination
- Data entry, administrative support
- Coordinating benefits and adjudication
- Training and developing procedures and protocols
Accomplishments
- Achieved fast track email protocols through effectively helping with assigning medical urgency to tasks
- Collaborated with team of 7 in the development of customer huddle theories and designated meetings.
- Collaborated with team of 2 in the development of claims auditing and line item reviews.
- Supervised team of 5 staff members.
- Used Microsoft Excel to develop inventory tracking spreadsheets., Data entry tracking, and tasks delegations.
- Documented and resolved urgent systems and platform issues which led to code misroutes, assignment errors, delegation errors being corrected in a timely fashion
Certification
- Basic Life Support Certification (BLS)
- First Aid Certification
- Driver's License- Illinois
- ServSafe Food Handler's Certification- Food protection manager certification
- Public health cottage food law operator
Languages
English
Full Professional
Timeline
MEDICAL MANAGEMENT COORDINATOR
HEALTH ALLIANCE MEDICAL PLANS
01.2014 - Current
Hacs - Customer Services Client Support Rep2
Health Alliance Medical Plans
12.2011 - 01.2013
SITE SECURITY OFFICER
CARLE FOUNDATION HOSPITAL
01.2010 - 01.2011
Bachelor of Science - Applied Sciences
EASTERN ILLINOIS UNIVERSITY
Associate of Applied Science - Criminal Justice- Appliced Sciences
PARKLAND COLLEGE
Highschool -
HERITAGE HIGHSCHOOL
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