Shelby Wilson
Peoria,AZ
Summary
Dedicated healthcare professional offering 7 years experience in organizations. Detail-oriented, observant and knowledgeable with healthcare admission and benefits including excellent documentation skills. Efficiently handle high case volumes with accuracy, care, and abiding by HIPAA guidelines.
Overview
10
10
years of professional experience
Work History
Benefit Investigation Specialist
Shared Services Center - Fort Smith
Peoria, AZ
09.2023 - Current
- Provide professional, accurate, and timely insurance verification and notification for outpatient diagnostic services, observation, and inpatient services.
- Responsible for the timely verification of medical insurance benefits for the service scheduled or service being provided via website and/or calling the payor (Managed Care payors, Governmental payors and Commercial payors).
- Using payor websites and documentation provided by the physician’s office determine if the scheduled service is medically necessary based on payor guidelines by CMS and commercial payors.
SR Health Services Associate
McKesson Specialty Health
Peoria, AZ
08.2020 - Current
- Making outbound calls to obtain benefit and prior authorization requirements from payors.
- Ensure patient medical and pharmacy services are covered.
- Generating benefit summaries.
- Operating according to the guidelines of the Federal Health Care Program.
- Data entry.
Patient Account Specialist
Banner Healthcare
Glendale, AZ
04.2019 - 06.2020
- Verifies and understands insurance benefits, collects patient responsibility based on estimates at the time of service, or during the pre-registration process.
- Acts as a liaison between the patient, the billing department, vendors, physician offices, and the payor to enhance account receivables performance and meet payment collection goals, resolve outstanding issues, and/or patient concerns, and maximize service excellence.
- Communicates with physicians, clinical and hospital staff, nursing, and Health Information Management Services to resolve outstanding issues and/or patient concerns. Works to meet the patients' needs in financial services.
Case Aide
Echelon
Phoenix, AZ
05.2018 - 09.2018
- Supervising the visits to ensure a safe, secure environment and completing appropriate documentation. Documenting the entire visit in detail for court processing.
- Supervise the visit between non-custodial parents and their child(ren).
- Report, as soon as possible, any problems or concerns regarding child, parent, or issues at visitation.
- Monitoring and, if necessary, intervening with the parent or child when inappropriate behaviors are demonstrated.
Replacement Team Lead
Chase Bank JP Morgan
Tempe, AZ
03.2017 - 07.2018
- Setting goals for performance and deadlines, including monitoring employee productivity, and providing constructive feedback and coaching.
- Making outbound calls to merchants/customers to determine valid charges on customers' credit cards.
- Utilizing different tools to investigate fraud transactions (Lexine, Customer Assist, C3, FIR, ATS).
Subject Matter Expert
Alorica
Phoenix, AZ
12.2014 - 03.2017
- Monitoring agents' inbound calls from members/providers to complete prior authorizations over the phone, via fax.
- Making outbound calls to members to ensure they receive their medication in a timely manner.
- Taking escalation calls for agents when the member/provider requests to do so.
- Assisting with trainings/refreshers when new procedures are rolled out.
Education
Bachelor of Science - Industrial And Organizational Psychology
University of Phoenix
Tempe, AZ10-2023
Some College (No Degree) - Pharmacy Technician
Carrington College - Phoenix
Phoenix, AZ11-2014
GED -
Rio Salado
Phoenix, AZ02-2013
Master of Science - Health Administration
University of Phoenix
Tempe, AZSkills
- Critical Thinking
- Benefit explanation
- Team Training
- Team Leadership
- Coaching and Mentoring
- Complex Problem Solving
- Fraud identification
- Microsoft Office Suite
- Case reporting
- Coverage Determination
Timeline
Benefit Investigation Specialist
Shared Services Center - Fort Smith
09.2023 - Current
SR Health Services Associate
McKesson Specialty Health
08.2020 - Current
Patient Account Specialist
Banner Healthcare
04.2019 - 06.2020
Case Aide
Echelon
05.2018 - 09.2018
Replacement Team Lead
Chase Bank JP Morgan
03.2017 - 07.2018
Subject Matter Expert
Alorica
12.2014 - 03.2017
Bachelor of Science - Industrial And Organizational Psychology
University of Phoenix
Some College (No Degree) - Pharmacy Technician
Carrington College - Phoenix
GED -
Rio Salado
Master of Science - Health Administration
University of Phoenix
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