SHAWNTAL PIERSON
Shenandoah,TX
Summary
Experienced in benefits advocacy and customer service with proficiency in medical billing. Skilled at navigating complex issues, leading teams, and implementing effective marketing strategies to enhance client relations and streamline budgetary processes. Expertise in training and compliance ensures seamless integration with industry regulations. Eager to leverage diverse skills and experience to thrive in a fast-paced environment.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Medicaid Claims Analyst
Elevance Health
11.2024 - Current
- Successfully processed and resolved over 2,200 Medicaid claims monthly, achieving a 98% accuracy rate and reducing processing time by 25%.
- Identified and resolved systemic issues within the Medicaid claim adjudication process, leading to a 60% reduction in claim rejection rates.
- Successfully identified and resolved discrepancies in claims submissions, leading to a 30% reduction in denied claims.
- Collaborated with healthcare providers to ensure correct documentation, increasing approval rates by 40%.
- Conducted detailed audits of Medicaid claims, which resulted in identifying recoverable funds for the organization.
- Analyzed claim rejection trends and provided actionable insights, leading to the implementation of best practices that decreased rejection rates by 25%.
Senior Benefits Advocate
United Healthgroup
08.2022 - 10.2024
- Tasked with reducing response time for tier 2 support queries, developed a priority triage system, cutting average inquiry resolution time.
- Faced challenges in resolving complex benefit disputes, a robust issue-tracking system devised, decreasing unresolved escalations within the first quarter.
- Confronted with client confusion over insurance claims, developed a claims education toolkit, improving client understanding and reducing follow-up queries.
- Identified inefficiencies in existing procedures impacting client satisfaction, spearheaded a process improvement initiative, resulting in a positive increase in client feedback.
- Assigned complex healthcare regulation adherence, revised compliance checklists, ensuring 100% compliance across all departments within one audit cycle.
- Challenged by extensive claims backlog, developed a rapid response task force, clearing backlog and adhering to timeframes with great success rate.
- Addressed chronic discrepancy detection issues, initiated comprehensive data audits, reducing errors over six months.
- Entrusted with improving member policy selection, utilizing data-driven insights, enabling an increase in customer satisfaction with policy choices.
- Tasked with handling high call and chat volumes, optimized remote assistance protocols, improving response rates and reducing client wait times.
- Delegated with verifying vast RX claims, introduced an automated verification tool, increasing efficiency and reducing errors.
Benefits Advocate Team Lead
Randstad
06.2018 - 07.2022
- Challenged with managing inefficient workflows in a high-volume call center; streamlined daily operations through process optimization, resulting in a 20% increase in call handling efficiency.
- Handled surging customer dissatisfaction; established a dedicated complaints resolution protocol, which reduced complaint resolution time by 40% and elevated the Net Promoter Score by 15%.
- Tackled recurring conflicts within customer interactions; implemented a needs analysis framework to better understand and address issues, resulting in a 25% decline in conflict-related escalations.
- Observed lapses in policy implementation; spearheaded a policy awareness campaign, leading to a 20% increase in operational adherence and improved overall compliance rates.
- Identified potential safety hazards in the work environment; enforced stringent safety regulations and regular audits, resulting in a 30% reduction in reported incidents.
Medical Biller
Bricken & Associates
05.2015 - 05.2018
- Addressed the challenge of delayed insurance claims processing by overhauling the billing system; led to a 20% faster claim approval rate and accelerated patient payment turnaround.
- Tackled recurring billing discrepancies with healthcare providers by establishing a streamlined communication protocol; achieved a 40% decrease in unresolved issues and enhanced provider relationships.
- Faced numerous patient account inquiries due to unclear insurance details; introduced an educational tool to aid patient understanding, resulting in a 45% decrease in inquiries and higher customer satisfaction.
- Ensured compliance with evolving HIPAA and billing standards amidst regulatory changes; developed an ongoing training module, leading to a 100% compliance rate in audits.
Education
Bachelors - Healthcare Administration
Southern New Hampshire University
05.2026
High school Diploma - undefined
Oak Ridge High School
Conroe, TX05.2010
Skills
- ONXT System- Live Chat- Zendesk- Ticketing System- CRM Proficiency- Adobe- Scheduling- ICD 9 & 10- Notion- Data Entry
- Problem Solving- Time Management- Customer Service- Team Leadership- Conflict Resolution- Attention to Detail- Persuasive Communications- Strong Interpersonal
- Benefits Advocacy- Medical Billing- Client Relations- Budget Management- Process Improvement- Staff Training- Compliance Healthcare
- Managing Daily Operations- Resolving Discrepancies- Implementing Marketing Strategies- Handling Billing Processes- Managing Client Interactions- Training New Employees- Verifying Insurance Claims
Certification
- Cosmetology Operator / Instructor
- Paul Mitchell Houston | Feb 2016 - Present
- Licensed Cosmetologist
- Successfully completed a certified skincare course covering advanced facial techniques, product knowledge, and dermal therapy.
- Eyelash Extension Certification
- Licensed Cosmetology Instructor: Hold an active state-issued cosmetology instructor license, allowing for the development and leadership of future beauty professionals through expert curriculum delivery and hands-on training.
- CPR and First Aid Certified: Trained and certified in CPR and First Aid, ensuring a safe learning environment and preparedness for any emergency scenario within the classroom.
Languages
English
Timeline
Medicaid Claims Analyst
Elevance Health
11.2024 - Current
Senior Benefits Advocate
United Healthgroup
08.2022 - 10.2024
Benefits Advocate Team Lead
Randstad
06.2018 - 07.2022
Medical Biller
Bricken & Associates
05.2015 - 05.2018
Bachelors - Healthcare Administration
Southern New Hampshire University
High school Diploma - undefined
Oak Ridge High School