SHAWNTAL PIERSON
Shenandoah
Summary
Strategic healthcare leader with deep expertise in claims resolution, benefits navigation, and member advocacy. Skilled in translating complex information into clear, actionable insights that optimize processes, elevate member experience, and enhance stakeholder understanding in dynamic, fast-paced environments. Proven success driving KPIs, closing quality gaps, and facilitating smooth access to care through collaborative problem solving and operational excellence.
Proficient in data entry, prior authorization, provider referrals, and Microsoft Office tools to streamline workflows and improve efficiency. Known for empowering remote teams, building trust, and designing career development programs that foster individual and organizational growth. Brings vision, direction, and a heart for equity to every initiative. Eager to transition comprehensive healthcare knowledge into a management role overseeing healthcare billing operations, compliance, and equity-centered outreach.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Claims Manager
Elevance Health
11.2024 - Current
- Act as escalation point for case complexity and adjust workloads accordingly.
- Propose workflow refinements to improve claim adjudication and customer satisfaction.
- Manage high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Direct daily operations, ensuring KPIs/SLA benchmarks are consistently exceeded.
- Identify and close claim rejection gaps (90% reduction).
- Process UB-04 and CMS-1500 claims, review forms for accuracy, and verify coverage.
- Ensure Medicaid/Medicare claims compliance with CMS regulations.
- Maintain strict confidentiality with all personal data as per company guidelines.
Senior Benefits Manager
United Health Group
08.2022 - 10.2024
- Delivered mentorship and performance feedback to Claims Specialists.
- Facilitated career development goals and metrics tracking for all team members.
- Designed triage models accelerating Tier 2 claims resolution.
- Optimized client compliance through revised documentation standards.
- Conducted team coaching aligned with performance goals and audit metrics.
- Supported business-impacting projects through documentation, training, and delivery planning.
- Coordinated patient referrals and prior authorization requests, improving care access.
- Utilized HCPCS and CPT codes knowledge to streamline claims processing.
- Reviewed claim denials and assisted with appeal procedures.
- Translated complex Explanation of Benefits (EOB) information into clear, accessible language for members, significantly improving comprehension and reducing follow-up inquiries.
Benefits Advocate Team Lead
Randstad
06.2018 - 07.2022
- Supported members with benefits navigation, claims resolution, and healthcare plan inquiries.
- Acted as liaison between clients and providers to ensure smooth benefits coordination.
- Delivered customer care with empathy and accuracy, improving member satisfaction.
- Assisted with insurance claims, prior authorizations, and benefits advocacy.
Medical Biller
Bricken & Associates
05.2015 - 05.2018
- Streamlined billing workflows to improve claim approval turnaround.
- Authored internal HIPAA training modules supporting regulatory alignment.
- Improved provider communication and dispute resolution processes.
- Verified insurance eligibility and managed appeals for denied claims.
- Filed and updated patient information and medical records.
- Collected payments and applied to patient accounts.
- Prepared for benefit conference reviews.
Education
Bachelor of Science - Healthcare Administration
Southern New Hampshire University
06-2026
High school Diploma - undefined
Oak Ridge High School
Conroe, TX05.2010
Associate of Science -
Lone Star College
Conroe, TX05-2022
Skills
- Healthcare Billing & Claims Management: Health Navigation & Claims Strategy, Medicare/Medicaid/Commercial Adjudication, Claim Audits & Processing, UB-04 and CMS-1500 Claims
- Leadership & Operations: Remote Team Leadership & Mentorship, SLA Compliance & Performance Tracking, Quality Auditing & Escalation Management, Workflow Optimization
- Technical Proficiency: Microsoft Office Suite, SharePoint, Confluence, CMDBs, Facets, Maces, CWS, UNET,EZ Cap Salesforce
- Regulatory & Compliance Expertise: HIPAA Compliance, CMS Regulatory Compliance, Centers for Medicare and Medicaid Services (CMS)
- Clinical Knowledge: Inpatient and Outpatient Processes, Anatomy Knowledge, Acute Care
- Member Advocacy & Communication: Provider Referral Coordination, Prior Authorization, Customer Service, Explanation of Benefits (EOB) Translation
- Training & Development: Macro Trainer, Career Development Program Design, Internal HIPAA Training Module Authoring
Certification
- 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.
- Licensed Cosmetologist
- 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.
Timeline
Claims Manager
Elevance Health
11.2024 - Current
Senior Benefits Manager
United Health Group
08.2022 - 10.2024
Benefits Advocate Team Lead
Randstad
06.2018 - 07.2022
Medical Biller
Bricken & Associates
05.2015 - 05.2018
High school Diploma - undefined
Oak Ridge High School
Bachelor of Science - Healthcare Administration
Southern New Hampshire University
Associate of Science -
Lone Star College