Sheena Marsh
Houston
Summary
Healthcare professional with extensive experience in managing reimbursement tasks and resolving billing discrepancies. Proven ability to streamline processes and improve efficiency while maintaining compliance with industry standards. Valued team player who consistently achieves results through effective collaboration and adaptability.
Knowledgeable Reimbursement Specialist with solid history in managing complex reimbursement processes and resolving billing issues. Efficiently handled claims and appeals, ensuring compliance with regulatory requirements and minimizing denials. Demonstrated analytical skills and attention to detail in optimizing reimbursement strategies.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Pharmacy Reimbursement Specialist
Accredo Health Group / Express Scripts / Cigna
10.2022 - Current
- Process pharmacy claims/payments
- Entered insurance coverages into via Pmm systems
- Verified patient’s benefits
- Effectively communicate with physicians an nurses regarding patients prior authorizations.
- Outbound calls to patients regarding assistance programs/copays
- Reviewed RX cases and eligibility for Narcolepsy/Cataplexy patients.
- Adhere to Hippa guidelines, policies and procedures
- Managed patient medication inquiries, ensuring timely and accurate responses to enhance customer satisfaction.
- Collaborated with healthcare providers to streamline prescription processes, improving workflow efficiency across teams.
Senior Customer Service Representative
Cigna
11.2018 - 10.2022
- Assist with escalated calls.
- Initiated grievances, appeals and prior authorization.
- Educated members on benefits and procedures.
- Answers over 50-60 calls per day.
- Assisted with Eligibility/ enrollment inquires
- Assisted with medical/RX claims inquires
Customer Service Representative
Harris County Toll Road Authority
01.2014 - 07.2018
- Process payments over the phone
- Educated /Upsold callers on the benefits of opening an EZ tag account.
- Answer all questions the caller had on the existing EZ tag account.
- Answered over 65 calls per day.
Loan Officer
Texas Car Title and Payday loan
11.2012 - 01.2014
- Proficient in all phases of the collection process
- Document customer contacts and commitments according to procedure
- Process ACH accounts timely and accurately
- Conduct bank calls and bank runs.
Education
Bachelor of Science - health administration
University of Phoenix-Online Campus
01.2026
Skills
- Basic Computer Troubleshooting
- Word, Excel, Powerpoint
- Communication skills include: written, verbal, and public speaking
- Above average software navigation skills
- Medical terminology
- Medical office experience
- Medical billing
- Medical scheduling
- English
- HIPAA
- Customer service
- DME
- Time management
- Commercial cleaning
- Insurance verification
- Communication skills
- Microsoft Excel
- Microsoft Office
- Microsoft Outlook
- Customer support
- ICD-10 coding
- HIPAA compliance
- HCPCS coding
- Appeals handling
Certification
- BLS Certification
- June 2024 to Present
Timeline
Pharmacy Reimbursement Specialist
Accredo Health Group / Express Scripts / Cigna
10.2022 - Current
Senior Customer Service Representative
Cigna
11.2018 - 10.2022
Customer Service Representative
Harris County Toll Road Authority
01.2014 - 07.2018
Loan Officer
Texas Car Title and Payday loan
11.2012 - 01.2014
Bachelor of Science - health administration
University of Phoenix-Online Campus