Sheerine Hairston
Midlothian,VA
Summary
To obtain a position as a Recovery Specialist I that will showcase my outstanding abilities and my valued higher education and help assist the current success of the company.
Overview
3
3
years of post-secondary education
14
14
years of professional experience
Work History
Claims Representative ll
Elevance Health
Roanoke, Virginia
02.2019 - Current
- Processed a high volume of claims efficiently while maintaining quality standards.
- Delivered quality customer service to insured and claimants throughout the claims process, ensuring timely service and support.
- Process complex health and dental claims, apply benefits information and work with minimal guidance
- Investigated claim discrepancies, correcting payment, coding, and documentation issues to ensure accurate claim resolutions.
- Evaluated prior authorization and eligibility details for claim approval decisions.
- Communicated claims status with providers, members, and internal service teams.
- Reviewed and verified claim information to ensure accuracy of data and compliance with established policies.
- Adhered to strict guidelines pertaining to confidentiality while handling sensitive personal information.
- Resolved complex discrepancies in policyholder files, facilitating accurate and efficient claim processing.
Accounts Receivable Specialist HMO/Other Insurance, Medicare Denials
Laboratory Corporation of America, Holdings
McLeansville, NC
01.2017 - 02.2019
- Contributed to standard operating processes by identifying and categorizing denial types
- Excellent adjustments to specimen balances, knowledge of ICD9/ICD10 diagnosis and CPTs
- Successfully trained and guided new and experienced employees by department and supervisor
- Supported supervisor with training inquiries and problem-solving, addressing issues in standard operating processes
- Communicated with project specialists to gather information from analysts and insurance carriers
- Used various systems to update Resubmission Book, Docfinity, Document Direct, LCBS, TurnStyle, MyStyle, Nvision, Template Hub, DSC, MPower, Sessions, Macros
- Completed cross-training in copay processes, name and number verification, and various insurance plans including Medicare, Medicaid, and Medicare HMO.
- Fostered a respectful and open communication environment among all employees
Technical Support Representative
The Results Companies
Collinsville, VA
07.2016 - 01.2017
- Troubleshot customer connectivity issues for modems, routers, and combination devices.
- Assist customers by identifying research answers, guiding customers through correct steps
- Checked outage page for known problems and verified router status to identify service interruptions
- Communicated with customer interaction by opening a ticket in a trouble ticketing system
- Communicated with internal and external customers
- Promoted a supportive work environment by maintaining a positive attitude towards coworkers and customers. toward coworkers and customers
Customer Advocate
United Health Group
Greensboro, NC
02.2014 - 03.2016
- Guided and educated customers in selecting optimal benefit plan options
- Provide and educate customers on the status of previously submitted pre-authorizations/pre-determinations
- Research claims and work with support resources to resolve customer issues
- Provide and educate customers on the status of previously submitted pre-authorizations/pre-determinations
- Exceeded performance goals in efficiency, call quality, customer satisfaction, and first call resolution
Operations Center Agent
ICF International
Martinsville, VA
06.2012 - 02.2014
- Collaborated with team members to enhance project outcomes with the ability to work in a fast-paced environment
- Adapted to changing priorities in a dynamic work environment to handle multiple tasks.
- Coordinated with management and colleagues to meet department goals
- Conducted initial client assessment and analysis to initiate research process
Education
Associate of Science - Office Technology Professional
American National University
Martinsville, VA 12.2010 - 05.2014
Skills
- Claims adjudication
- Prior authorization
- Benefits verification
- Denial resolution
- Claims documentation
- Healthcare billing
- Insurance processing
- Claims Processing Software
- Versatile Training
- Time Management
- Adaptability
- Interpersonal Communication
- Willingness to Learn New Things
Timeline
Claims Representative ll
Elevance Health
02.2019 - Current
Accounts Receivable Specialist HMO/Other Insurance, Medicare Denials
Laboratory Corporation of America, Holdings
01.2017 - 02.2019
Technical Support Representative
The Results Companies
07.2016 - 01.2017
Customer Advocate
United Health Group
02.2014 - 03.2016
Operations Center Agent
ICF International
06.2012 - 02.2014
Associate of Science - Office Technology Professional
American National University
12.2010 - 05.2014