Shawunna Clark
Health Coordinator
Crandall,TX
Summary
Detail-oriented Medicare/Medicaid coordinator with expertise in managed projects and operational compliance. Skilled in training development and customer centered support, contributing to improved workflow and team collaboration. Adept at facilitating training sessions and ensuring compliance, leading to enhanced team productivity and operational efficiency.
Overview
10
10
years of professional experience
Work History
Coordinator, Medicare/Medicaid
Blue Cross Blue Shield of Texas
Richardson
11.2023 - Current
- Coordinated communication between departments to streamline project workflows.
- Assisted in preparing reports for team meetings and presentations.
- Supported training sessions for new hires on operational procedures.
- Organized resources to enhance operation efficiency.
- Conducted research to support program development and implementation initiatives.
- Facilitated communication between different departments in order to resolve issues quickly.
- Monitored inventory levels and provided feedback as needed to lower the pending inventory of advocates.
- Ensured compliance with company policies and procedures related to project management activities.
- Facilitated information sharing through effective use of collaboration tools.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Delegated work to staff, setting priorities and goals.
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity, by creating Standard Operating Procedures.
- Consulted with managers to resolve problems related to employee performance.
- Reviewed employees' work to check adherence to quality standards and proper procedures.
Health Advocate
Blue Cross Blue Shield of Texas
Richardson
03.2020 - 11.2023
- Advocated for patient needs through effective communication with healthcare providers.
- Educated clients on available health resources and services tailored to individual needs.
- Coordinated patient care among multiple providers in the healthcare system.
- Provided health education and resources to patients.
- Maintained accurate documentation of all patient interactions in accordance with HIPAA regulations.
- Managed many health plan-related calls in fast-paced call center environment.
- Answered questions on diverse topics, including authorization procedures, copay requirements and premiums.
- Helped people enrolled in different plans, arrange transportation, and coordinate paperwork.
- Notified individuals regarding appointment follow-ups and referrals and provided transportation to appointments.
Verification Specialist
Globe Life And Accident Insurance Company
McKinney
08.2018 - 12.2019
- Reviewed insurance applications for accuracy and completeness.
- Verified compliance with company policies and state regulations.
- Documented findings and maintained organized records of verifications.
- Utilized software systems to track application status and updates.
- Communicated effectively with clients to resolve verification issues.
- Performed verification of customer accounts and ensured data accuracy.
- Responded promptly to inquiries from customers regarding their account status or verification process.
- Reviewed incoming documents for completeness, accuracy, and compliance with established standards.
- Researched and evaluated customer information for compliance with internal policies and procedures.
- Identified potential fraudulent transactions by monitoring for suspicious patterns or behaviors.
- Investigated discrepancies in customer accounts to determine root cause and resolution.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Managed multiple tasks and priorities in a high-volume, fast-paced environment.
- Met with supervisor daily to submit completed assignments and discuss progress.
Customer Service Representative
Hoya Vision Care
Lewisville
04.2016 - 08.2018
- Managed customer accounts and updated information in the database.
- Handled high-volume calls and maintained composure under pressure.
- Documented customer feedback for continuous improvement initiatives.
- Answered customer inquiries and provided accurate information regarding products and services.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Developed strong customer relationships to encourage repeat business.
- Assisted customers with product selection, ordering, billing, returns, exchanges and technical support.
- Resolved complex problems by working with other departments to provide solutions that meet customer needs.
- Informed customers about billing procedures, processed payments, and provided payment option setup assistance.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Tracked orders from start to finish to ensure timely delivery of goods or services.
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
- Updated databases with new and modified customer data.
- Liaised between customers and retail buyers to expedite orders and meet customer demands.
Enrollment Reconciliation Specialist
United Healthcare, UHG
San Antonio
10.2015 - 08.2016
- Tracked payments made through ACH and Wire transfers, verifying information against banking records.
- Performed month-end close activities related to the reconciliation process.
- Collaborated with cross-functional teams to resolve discrepancies and issues.
- Utilized accounting software to streamline reconciliation workflows and improve efficiency.
- Conducted regular audits of reconciled accounts to ensure ongoing accuracy.
- Collaborated with internal departments to resolve discrepancies quickly and accurately.
- Researched and resolved complex reconciliation issues in a timely manner.
- Reconciled intercompany transactions on a monthly basis to ensure accurate reporting of results.
- Reviewed internal data against information received from Social Security Insurance to ensure members were penalty-free.
- Reviewed internal data against information received from Social Security Insurance to ensure members were enrolled in Medicare Parts A and B to avoid having to pay late enrollment fees.
Education
Associate of Science - Dental Hygiene
ATI Career Training Center
Richardson, TX01-2010
High School Diploma -
Mascoutah High School
Mascoutah, IL06.1997
Skills
- Managed Projects
- Data analysis
- Report preparation
- Operational compliance
- Resource coordination
- Customer Service Experience
- Experiential Training development
- Inventory management
- Team collaboration
- Strategic planner
- Onboarding New Hires
- MS office
- Team oversight
- Results-driven professional resource management
- Workflow acceleration
- Data entry
- Project coordination
Timeline
Coordinator, Medicare/Medicaid
Blue Cross Blue Shield of Texas
11.2023 - Current
Health Advocate
Blue Cross Blue Shield of Texas
03.2020 - 11.2023
Verification Specialist
Globe Life And Accident Insurance Company
08.2018 - 12.2019
Customer Service Representative
Hoya Vision Care
04.2016 - 08.2018
Enrollment Reconciliation Specialist
United Healthcare, UHG
10.2015 - 08.2016
Associate of Science - Dental Hygiene
ATI Career Training Center
High School Diploma -
Mascoutah High School