SHEMEKIA CUMMINGS
Chesapeake,VA
Summary
An observant and detail-oriented Qualified Mental Health Professional possessing knowledge of principles, methods, and procedures for diagnosis and treatment. Responsible self-starter with excellent interpersonal and communication skills. Dedicated to improving the wellbeing of clients and driven to help them overcome personal obstacles. Comfortable working autonomously or in a team-based setting.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Mental Health Intake Counselor
Superior Health and Wellness Group
01.2023 - 04.2023
- Managed and completed intake assessment forms for approximately 15+ patients weekly
- Administer mental health screenings to determine criteria for mental illness
- Collect, verify, record, and process client demographics, insurance payments, and referral information
- Document patient medical information, case histories, and insurance details to facilitate smooth appointments and payment processing
- Adhere to HIPAA laws and patient privacy
- Offer compassionate and attentive guidance to patients during moments of crisis and trauma.
Claims Benefit Specialist
CVS Healthcare
08.2021 - 02.2023
- Entered and processed 40+ claims per day
- Reviewed insurance and claims documents to verify required information and secure any missing data for payout.
- Reliable team resource-act as subject matter expert (SME) for others.
- Utilized appropriate cost containment techniques to reduce overall claim costs.
- Generated, posted, and attached information to claim files.
- Checked documentation for accuracy and validity on updated systems.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Volunteered for continuous training
- Responded proactively and positively to rapid change
- Sustained knowledge and ensure standard operating procedures were followed
- Conducted full claim investigations on complicated claims/medical authorizations and consulted with colleagues, as needed.
- Managed workload and priorities to meet claims processing meet deadlines.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Identified and reported potential fraud or abuse related to claims to protect system's integrity.
- Posted payments to accounts and maintained records.
Social Services Coordinator
Vivo Healthcare
02.2018 - 05.2020
- Advocated for 60+ post-acute patients with interdisciplinary team to address patient needs and treatment plans
- Conducted Brief Interview for Mental Status (BIMS) assessments
- Cultivated positive, trusting relationships with clients and community providers to promote effective coordination of resources
- Coordinated individual referrals to obtain community services, advocate for client needs and resolve roadblocks to meet treatment needs
- Utilized fax, email, and multi-line phone systems to communicate with providers, patients, and their authorized representatives regarding health status and goals
- Assisted with scheduling medical appointments and transportation
- Communicated with physicians and physician personnel to obtain accurate documentation/signatures for home health orders and durable medical equipment post-discharge
- Identified ways to support resident's individual needs, routines, concerns, and choices
- Reviewed medical records/charts for accuracy and obtained any missing documentation
- Gathered and entered all interactions with providers, patients, and their families into Electronic Medical Record (EMR) system
- Analyzed trends and data to inform decision-making and program development
- Gathered information from mental and physical health records to make recommendations and determine appropriate care plans
- Analyzed Pre-Admission Screening and Resident Review (PASRR) forms for discrepancies
- Reviewed grievances, determined root cause, and created action plan to align with CMS guidelines
- Provided crisis intervention, guidance, and supportive counseling to patients
Corporate Customer Service Representative
ADT Security
06.2012 - 05.2016
- Acquired caseload of approximately twenty customers per day
- Act as point of contact for grievances addressed to CEO, legal teams, and social media platforms in timely and compliant manner
- Demonstrated ability to gain/build rapport and comfortability with customers via phone
- Utilized customer service software to manage interactions and track customer satisfaction
- Promoted and developed highly empathetic client relationships and earned reputation for exceeding service standard goals
- Updated account information to maintain customer records
- Investigated and resolved customer inquiries and complaints effectively
- Actively listened to customers while talking, typing, and navigating multiple screens and resources
- Met customer call metrics for service levels, quality, and productivity by promoting operational practices
- Assured all calls were answered promptly and in polite manner
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
- Reduced process inconsistencies and effectively trained new team members on best practices and protocols
- Participated in team meetings and training sessions to stay informed about product updates and changes
- Followed through on all critical inter-departmental escalations to increase customer retention rates
- Implemented and developed customer service training processes
- Provided primary customer support to internal and external customers.
Emergency Dispatch Operator
ADT Security Services
04.2006 - 06.2012
- Managed 100+ outgoing telephone and alarm system calls daily and dispatched appropriate emergency services while documenting pertinent details simultaneously
- Recorded and tracked emergency requests utilizing computer-aided dispatch systems
- Proved successful working within tight deadlines and fast-paced environment
- Reported alarm activity to subscribers' emergency contacts and documented outcome.
Customer Care Team Lead
ADT Security Services
10.2010 - 07.2011
- Assist inbound and outbound agents daily with technical and call process inquiries
- Developed and updated databases to manage customer data
- Generated weekly and monthly reports to highlight customer service performance and measure milestones
- Responded to frustrated customer’s needs through competent customer service and prompt problem-solving
- Logged call information and solutions provided into internal database
- Sought ways to improve processes and services provided
- Analyzed customer feedback for process improvements to achieve long-term business objectives
- Increased efficiency and performance by monitoring team member productivity and providing feedback
- Implemented and developed customer service training processes.
Education
Bachelor of Science - Human Services
Florida State College at Jacksonville
Jacksonville, FL05.2018
High School Diploma - undefined
Edward H. White High School
Jacksonville, FL05.2004
Skills
- Empathetic
- Analytical thinking
- Exceptional problem solver
- Competent in PC use and Microsoft Office Tools
- Suicide Risk and Biopsychosocial Assessments
- Proficient typing abilities
- Superior communication skills
- Experience with Psychiatric/Geriatric population
- Knowledgeable in medical terminology
- Clinical document mastery
- Familiarity with dual diagnosis/mood disorders
Certification
- QMHP-A - Qualified Mental Health Professional, Adult
Timeline
Mental Health Intake Counselor
Superior Health and Wellness Group
01.2023 - 04.2023
Claims Benefit Specialist
CVS Healthcare
08.2021 - 02.2023
Social Services Coordinator
Vivo Healthcare
02.2018 - 05.2020
Corporate Customer Service Representative
ADT Security
06.2012 - 05.2016
Customer Care Team Lead
ADT Security Services
10.2010 - 07.2011
Emergency Dispatch Operator
ADT Security Services
04.2006 - 06.2012
Bachelor of Science - Human Services
Florida State College at Jacksonville
High School Diploma - undefined
Edward H. White High School
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