Summary
Overview
Work History
Education
Skills
Timeline
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SHEMEKA BRADLEY

Henderson,Nevada

Summary

Dynamic Clinical Administrative Coordinator with extensive experience at UMR @ UnitedHealthcare, excelling in project management and healthcare compliance. Proven track record in optimizing service requests and enhancing patient care through effective communication and meticulous documentation. Skilled in claims management and fostering provider relations, ensuring seamless operations and high-quality outcomes.

Overview

14
14
years of professional experience

Work History

CLINICAL ADMINISTRATIVE COORDINATOR

UMR @ UnitedHealthcare
06.2023 - Current
  • Managed service requests from members and providers across hospitals, clinics, and facilities.
  • Facilitated accurate authorizations through insurance verification and procedural coding analysis.
  • Created medical service authorizations for inpatient, outpatient, and therapy services.
  • Coordinated health care services in alignment with directives from medical professionals.

TEAM LEAD/BENEFIT VERIFICATION SPECIALIST

Aston Carter @ Amgen
10.2022 - 12.2023
  • Verified Primary, Secondary, and Tertiary insurance coverage through direct communication with insurance companies.
  • Documented all calls and benefit information systematically to maintain accurate records.
  • Provided leadership and guidance to team members, ensuring that tasks were completed on time and to a high standard.
  • Motivated staff through positive reinforcement techniques.

SENIOR LTD CLAIMS EXAMINER

Lincoln Financial Group
02.2022 - 10.2022
  • Coordinated technical processes for long-term disability claims necessitating detailed examination and accurate legal compliance.
  • Assessing disability claims for individuals facing long-term work limitations stemming from physical and mental disorders.
  • Review and exercise independent judgment on complex and unique policy coverages to assess coverage applicability for submitted claims
  • Evaluated disability claims and determined outcomes through sound, unbiased judgment leveraging available resources such as vocational and medical data

INSURANCE VERIFICATION/ CLAIMS REPRESENTATIVE

LifeStance Health
08.2020 - 02.2022
  • Interacted with providers through phone calls to acquire crucial information for thorough claims review
  • Authenticated patients' behavioral health benefits and executed authorizations as well as handled claims for Behavioral Health, EAP, STD, FMLA, and LTD claims
  • Evaluated case documentation for timely updates to patients and providers regarding pending claims and authorizations.
  • Processed a high volume of claims efficiently while maintaining quality standards.

TEAM LEAD/TEAM SME/TRAINING ASSISTANT

Walgreens Specialty Pharmacy
08.2017 - 08.2020
  • Conducted verification of patient insurance coverage regarding medications and pharmacy services.
  • Resolved escalated customer complaints or queries promptly and efficiently.
  • Maintained accurate records of employee attendance and task completion times.
  • Monitored team performance against targets, taking corrective action where necessary.
  • Facilitated prior authorization requests for medications with providers.
  • Managed updates to insurance details and patient information across accounts.

PATIENT CASE COORDINATOR

AmerisourceBergen/Lash Group
08.2016 - 08.2017
  • Received calls from patients, clinics, and doctors' offices regarding patient assistance with prescription drug coverage.
  • Screened and managed applications to establish eligibility for coverage under GSK Patient Assistance Program
  • Elevated customer experience through quality service to improve customer satisfaction
  • Provided patient-centered case management services to ensure quality care.
  • Assisted patients in accessing community resources and support systems.

TEAM SUPERVISOR/TEAM LEAD

Morneau Shepell
04.2014 - 08.2016
  • Facilitated member inquiries about billing and eligibility, ensuring clear communication.
  • Provided training and support to new employees to ensure they understand their job responsibilities.
  • Monitored team members' progress, provided feedback and guidance as needed.

DENTAL INSURANCE/CLAIMS REPRESENTATIVE

Randstad at Delta Dental Insurance Co.
08.2011 - 04.2014
  • Collaborated with dental office teams to set up service authorizations efficiently.
  • Assisted clients and office staff in resolving claims and understanding dental benefits.
  • Educated customers on insurance policy coverage, procedures, regulations.

Education

Capella University

TULSA COMMUNITY COLLEGE

Skills

  • Project management and prioritization
  • Planning and coordination
  • Operations management
  • Workflow organization
  • Space utilization
  • HIPAA
  • Medical terminology
  • Healthcare compliance
  • Provider relations
  • Telephone customer support
  • Microsoft Office proficiency
  • Multitasking and strategic thinking
  • Effective communication
  • Problem solving
  • Attention to detail
  • Time management
  • Medicare/Medicaid
  • Medical billing
  • Claims management
  • Clinical documentation
  • Documentation skills
  • Medical database expertise
  • Patient care
  • HIPAA compliant
  • Case management
  • Informed consent
  • Unit leadership
  • Metrics tracking

Timeline

CLINICAL ADMINISTRATIVE COORDINATOR

UMR @ UnitedHealthcare
06.2023 - Current

TEAM LEAD/BENEFIT VERIFICATION SPECIALIST

Aston Carter @ Amgen
10.2022 - 12.2023

SENIOR LTD CLAIMS EXAMINER

Lincoln Financial Group
02.2022 - 10.2022

INSURANCE VERIFICATION/ CLAIMS REPRESENTATIVE

LifeStance Health
08.2020 - 02.2022

TEAM LEAD/TEAM SME/TRAINING ASSISTANT

Walgreens Specialty Pharmacy
08.2017 - 08.2020

PATIENT CASE COORDINATOR

AmerisourceBergen/Lash Group
08.2016 - 08.2017

TEAM SUPERVISOR/TEAM LEAD

Morneau Shepell
04.2014 - 08.2016

DENTAL INSURANCE/CLAIMS REPRESENTATIVE

Randstad at Delta Dental Insurance Co.
08.2011 - 04.2014

Capella University

TULSA COMMUNITY COLLEGE

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