Jonetta Sheeley
NC
Summary
Thorough team contributor with strong organizational capabilities. Experienced in handling projects while ensuring accuracy. Effective at prioritizing tasks and meeting deadlines.
Overview
10
10
years of professional experience
Work History
Enrollment Associate Inside Sales
CVS Health
12.2019 - Current
- Analyze complex medical conditions and identify issues and solutions to improve service quality.
- Communicate program features and benefits effectively to members and achieve minimum of 6 enrollments daily.
- Stay informed about eligibility changes and new programs to enhance member education.
- Maintain strict confidentiality for all clients, including high-profile members, ensuring privacy and trust.
- Efficiently manage over 80 calls daily to meet production targets with strong call management skills.
- Ensure data accuracy and integrity across multiple databases for seamless project execution.
- Provide IT support during integration of EPIC/POM systems, ensuring successful testing and alignment with business objectives.
Surgery Scheduler -Claims Authorization
Carolina Eye Associates P.A.
01.2019 - 09.2019
- Maintain and prioritize scheduled appointments based on patient loads and clinician availability.
- Increase surgical services by 2-3 daily through effective scheduling and coordination.
- Coordinate with surgeons to determine procedures and procure necessary supplies and equipment.
- Prioritize appointments based on urgency, resource availability, and provider expertise to enhance operational efficiency.
- Reconcile expired authorizations and input insurance authorizations before patient services.
- Manage denied cases by sending them to surgeons for evaluation and potential appeal.
- Ensure accurate patient payment records and handle end-of-day collections and balances.
- Establish and maintain effective communication with internal and external partners, including providers, clinical staff, hospitals, and insurance companies.
- Foster collaboration to ensure smooth operations and efficient service delivery.
Intake Specialist - Prior Authorization
NTSP Silverback Care Management
01.2016 - 11.2018
- Reassign out-of-network providers to in-network providers to optimize member and provider benefits.
- Establish and maintain strong collaborative relationships with external providers and third-party entities.
- Process and expedite Durable Medical Equipment (DME) requests, ensuring timely referrals to relevant departments.
- Work with clinical team to submit and track authorization requests efficiently.
- Secure member cases and complete necessary claims paperwork to ensure seamless processing.
- Communicate with non-par providers to request additional clinical information when required, and document decisions via fax or mail.
Escalation Resolution Assistant Supervisor
Nco-Duke Energy
07.2014 - 01.2016
- Handle and complete resolution assignments in timely manner.
- De-escalate issues and investigate customer inquiries and complaints empathically.
- Collect delinquent accounts and manage customer interactions.
- Cross-train 3-4 new employees quarterly and develop training manual for reference.
- Back up supervisors when not available and provide support.
- Prepare production reports and ensure quality documentation.
Education
Strayer University
Washington, DCSkills
- Strong communication skills
- Scheduling & Document Coordination
- Attention to detail and organized
- Collaborative
- Interpersonal abilities
- Conflict resolution
- MS Office products, Database & Software Knowledge
Timeline
Enrollment Associate Inside Sales
CVS Health
12.2019 - Current
Surgery Scheduler -Claims Authorization
Carolina Eye Associates P.A.
01.2019 - 09.2019
Intake Specialist - Prior Authorization
NTSP Silverback Care Management
01.2016 - 11.2018
Escalation Resolution Assistant Supervisor
Nco-Duke Energy
07.2014 - 01.2016
Strayer University