Sheilah Fulton
Fayetteville,NC
Summary
Adept with technical and analytical skills including Microsoft Office (Word, PowerPoint, Excel and Outlook, CRM) SharePoint, EPIC, Millennium software proofreader, editing, etc. Managed complex multi-line telephone systems, upselling and typing speed 50-55 wpm Excel at developing strong relationships with staff and senior management and trusted by supervisors to handle confidential data. Public speaking Detailed oriented Troubleshooting of technical issues and password resets Published writer John Hopkins COVID-19 Contact Tracing course and training Dedicated administrative professional well-versed in communication and team building. Knowledgeable in medical terminology and scheduling. Ready to bring 10 years of relevant work experience to advance the company goals. Organized Patient Service Representative with 10 years of experience in healthcare. Adept at patient advocacy and education with a strong commitment to efficiency. Skilled at coordinating busy offices and maintaining professionalism in stressful situations.
Overview
10
10
years of professional experience
Work History
Patient Service Representative
AmerisourceBergen
Remote
01.2022 - Current
- Compiled and reviewed medical charts.
- Contributed to reduction of accounts receivables by adhering to predetermined policies and procedures to recover amounts due from patients.
- Resolved patient financial problems with guidance from documented guidelines and procedures.
- Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
- Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient privacy.
- Applied administrative knowledge and courtesy to explain procedures and services to patients.
- Helped address client complaints through timely corrective actions and appropriate referrals.
- Worked with patients to ascertain issues and make referrals to appropriate specialists.
- Facilitated communication among patients and various departments and staff.
- Maintained and management of over 100 patient electronic medical records.
- Reviewed and corrected claim errors to facilitate smooth processing
- Compiled and reviewed medical charts
Program Specialist
Covance Lab Corp
Remote, NC
11.2020 - 06.2021
- Checked account information for eligibility with program plans and guidelines.
- Effective liaison between customers and internal departments.
- Maintained up-to-date knowledge of product and service changes.
- Observed strict procedures to maintain data and plan participant confidentiality.
- Determined appropriateness of payers to protect organization and minimize risk.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Carried out front office duties utilizing data entry skills in framework of the medical database.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Handled benefit verifications in a timely manner to adhere to compliance
- Established goals and created action plans to achieve goals
- Entered data in Siebel system and handled database maintenance
- Processed eligibility and benefits verification and authorization requests
- Researched and resolved routine and complex issues
- Remained solutions-oriented in face of complex problems to assist management and overall business direction
Chart Retrieval Specialist
PRN
Raleigh, NC
12.2019 - 05.2020
- PRN as needed: Responsible for travel to clinics and hospitals for scanning and uploading electronic medical records, organization of EMRs, data collection, Established HEDIS data information, HIPAA compliance, etc
- Obtained necessary signatures on information release forms to obtain medical and treatment records from other service providers.
- Processed medical records requests from outside providers according to the facility, state, and federal law.
- Received and processed over 40 medical records requests daily.
- Actively listened to customers, handled concerns quickly, and escalated major issues to management.
Senior Intake Specialist
Accordant Care
Remote, NC
04.2018 - 09.2019
- Managed over 50 outbound calls, processed over 30 enrollments daily entered demographic information and personal health information on EPIC, data entry, management of member information, and health benefits
- Received incoming requests or New Patient Questionnaires and transcribed data into EPIC, established new workflow processes and updates on SharePoint.
- Determined eligibility for counseling and referral for over 30 clients daily
- Interacted kindly with insurance providers via phone, email, and written correspondence to obtain necessary documents to complete registration
- Offered compassionate and attentive guidance to patients during moments of crisis and trauma
- Answered phone calls and provided new clients with required paperwork to initiate service
- Completed intake assessment forms and filed clients' charts
HEDIS Compliance Auditor
McKesson Specialty Health
Alpharetta, GA
01.2018 - 04.2018
- Responsible for documentation and retrieval of information on OPM Management System for over 50 daily outbound calls to providers, clinicians, and hospitals regarding EMR Maintained HIPAA compliance Health informatics and patient assistance
- Advised on EMR submission protocols Secured and maintained release of information and PHI ( personal health information) Data entry, typing, computer systems, and updated provider demographics.
- Determined customer needs and developed program initiatives according to preferences
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Handled day-to-day running of HEDIS audits, ensuring high levels of productivity and progression.
- Demonstrated respect, friendliness, and willingness to help wherever needed.
Patient Care Advocate Advisor
Humana
Cincinnati, Ohio
07.2016 - 07.2017
- Responsible for Group Medicare health and pharmacy claims Benefits/eligibility advisor CRM management.
- Performed account audits to ensure accuracy of PHI and updated demographic information.
- Educated members on health plans, coinsurance, deductibles, and copay information and provider relations Maintained knowledge on group insurance plans, grievances, researched claim processing issues, vendor relations, benefits, and eligibility, HIPAA compliance, authorizations, correspondence, handled all inbound calls from members and competently handled PHI ( personal health information) with providers and agents, assisted in troubleshooting and reset of passwords, scanning, and handled all faxes, etc.
- Handled 30-50 calls per day to address customer inquiries and concerns
- Resolved conflicts and negotiated mutually beneficial agreements between parties
- Maintained energy and enthusiasm in fast-paced environment
- Actively listen to customers' requests, confirming full understanding before addressing concerns
- Resolved problems, improved operations, and provided exceptional service
- Proved successful working within tight deadlines and afast-paced atmosphere
Customer Care Specialist
Anthem
Cincinnati, Ohio
12.2015 - 07.2016
- Handled benefit and eligibility calls for Federal Employee Program Composed letters for correspondence to members and providers Administered Benefits and maintained confidentiality of personal health information Addressed insurance claim calls, etc.
- Adherence to HIPAA policies and implementation of HIPAA breach Explanation of Benefits (EOB) Medical records Verified ICD 9 and ICD 10 CPT coding, revenue, and remark codes.
- Streamlined operational efficiencies by managing accounts and contracts and processing system orders and cancellations
- Assessed caller accounts to determine health benefits, identify service needs and resolve issues
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences
- Met all customer call guidelines including service levels, handle time and productivity
- Defused customer concerns with exceptional conflict and problem resolution skills
- Responded to customer needs through competent customer service and prompt problem-solving
Substitute teacher & Teacher Assistant
Fulton County Public Schools
Atlanta, GA
01.2011 - 12.2015
- Facilitated learning K-12 various topics, classroom management, documentation of student records, grade management, proctored exams, supervised small group learning, bus duty, extracurricular supervision, conduct and absentee documentation, counseled students as needed , etc.
- Assigned, explained and graded homework
- Upheld classroom routines to support student environments and maintain consistent schedules
- Took over class for regular classroom teacher, managing assignments, student needs and recordkeeping
- Kept students on-task with proactive behavior modification and positive reinforcement strategies
- Followed classroom plans left by class teacher to continue student education and reinforce core concepts
- Diversified classroom instruction and group activities to successfully support students with unique strengths and learning styles
- Implemented outlined grading and assessment techniques to document growth, development and knowledge advancements during teacher absence
- Maintained day-to-day classroom management and discipline to promote learning initiatives
- Assisted students of all ability levels develop life-long learning skills and good study habits
Human Resource Assistant
Henrico County School Board
Richmond, VA
08.2010 - 01.2011
- Responsible for scheduling interviews for school board, answered central phone line and questions about employment, employment benefits, advised on benefits and schedule updates, fingerprinted employees for ID badges, multi phone lines, filing and scanned employment records, created and secured personnel files, etc.
- Answered and directed 15-30 outbound and inbound phone calls per day
Education
Master of Science - Community Health Services
Walden University
Minneapolis, MN09.2021
MBA - Health Care Management, Business Administration/ Health Care Management
Saint Leo University
Tampa05.2012
Bachelor of Science -
St Leo University
Tampa03.2009
Skills
- Data management familiarity
- Proactive mindset
- Resolving Problems
- Quality Standards and Protocols
- Microsoft Office, SalesForce, Teams, and Sharepoint
- Communicating to Patients and Families
- Organized and Efficient
- Database Search and Data Entry Skills
- Verbal and Written Communication
- Caring and Empathetic
- Gathering Information from Patients
- Patient Confidentiality and Data Security
- Documenting and Recording Information
- Calm and Effective Under Pressure
- Medical Transcription
- Reliability and Dedication
- Outbound Calling
- Health Information Access Management
- 55 WPM Typing Speed
Timeline
Patient Service Representative
AmerisourceBergen
01.2022 - Current
Program Specialist
Covance Lab Corp
11.2020 - 06.2021
Chart Retrieval Specialist
PRN
12.2019 - 05.2020
Senior Intake Specialist
Accordant Care
04.2018 - 09.2019
HEDIS Compliance Auditor
McKesson Specialty Health
01.2018 - 04.2018
Patient Care Advocate Advisor
Humana
07.2016 - 07.2017
Customer Care Specialist
Anthem
12.2015 - 07.2016
Substitute teacher & Teacher Assistant
Fulton County Public Schools
01.2011 - 12.2015
Human Resource Assistant
Henrico County School Board
08.2010 - 01.2011
Master of Science - Community Health Services
Walden University
MBA - Health Care Management, Business Administration/ Health Care Management
Saint Leo University
Bachelor of Science -
St Leo University
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