Shemethia Dyer
Clarkston,United States
Summary
Healthcare Admin Professional with 17+ years of extensive expertise, dedicated to revolutionizing patient care and administrative processes. Excels in people skills and advanced communication, driving efficiency and innovation in healthcare service delivery. Committed to continuous learning and adapting to enhance healthcare outcomes.
Overview
19
19
years of professional experience
Work History
Senior Care Coordinator
Ennoble care
04.2021 - 08.2024
- Liaison between patients, healthcare professionals, and insurance carriers
- Listening to clients’ concerns and providing counseling or intervention as required
- Utilize my skills and healthcare industry expertise to efficiently solve insurance-related issues to process patient prescription orders for on-time delivery
- Utilize my skills and healthcare industry expertise to efficiently solve patient healthcare inquiries, DME supply orders, lab orders, radiology orders
- Speaking with patients, families, and others to maintain sound community relations
- Review medical charts to compile information for healthcare team messages, ensuring timely communication
- Responsible for coordinating the delivery of appropriate and timely care for patients, promoting quality and cost-effective healthcare outcomes
- Analyze and process healthcare claims, maintaining accuracy and compliance with regulations
- Coordinate patient appointments and treatment plans, enhancing patient care and satisfaction
- Oversee medical service activities and personnel, ensuring efficient operations and high-quality care
- Update electronic health records, maintaining accurate and up-to-date patient information
- Spearheaded cross-functional projects, fostering team collaboration and delivering innovative solutions that drove substantial business growth
- Verify patient insurance benefits, explain benefits to patients, obtain authorizations
- Complete accurate intake packets for staff and patients
- Serve as a liaison between patients, staff, and clinical manager
- Respond promptly to all customer service issues and concerns
- Greet patients and visitors and direct them accordingly
- Scheduling of new patients and follow-up appointments
- Obtain insurance authorization to process patients for services needed
- Collect and process copays as appropriate
- Assist patients with the check-in process and completing their portion of patient history in the EMR
- Answer incoming phone calls and assist callers or direct calls accordingly
- Communicate the status of all patients and requests to clinical staff, physicians, or center manager to ensure continuous operation of the center
- Provide pertinent documentation to Clinical Manager for review regarding all referral sources
- Trains new employees in the company’s customer service policies, procedures, and best practices
- Organizes and oversees the schedules and work of assigned staff
- Conducts performance evaluations that are timely and constructive
- Handles discipline and termination of employees as needed and in accordance with company policy
- Collects, interprets, and assesses information regarding the patient’s prescribed specialty medication and associated health conditions while maintaining high-quality patient care and customer service.
Senior Healthcare Claims Specialist
North Atlanta Primary Care Duluth
03.2019 - 03.2021
- Appeals and resolutions
- Insurance aging and follow-up
- Identify and correct discrepancies in claims
- Verify and audit chart and coding discrepancies
- Timely submission of clean electronic claims
- Posting of insurance and patient payments
- Manage patient claims and monitor patient progress through treatment
- Review claim ERA, manage denials, correct claims, and resubmit per insurance guidelines
- Review and process medical claims to ensure they are legitimate, accurate, and eligible for reimbursement
- Work to determine if payments are due and follow up to ensure procedures took place and claims are not fraudulent
- Following up with treatment status, communicating with insurance companies, other medical providers, and the law firm
- Analyze Explanation of Benefits (EOB) and payment remittance documents submitted by healthcare providers and insurance carriers to determine which claims are eligible for the dispute resolution process
- Verify patient eligibility, contact other healthcare providers to ensure the accuracy of medical records, and assign clinical codes via classification
- Compose correspondence in accordance with regulatory requirements (and internal policies and procedures) in a clear, concise, and grammatically correct manner
- Communicate (via email) with healthcare providers and health plans to obtain necessary information and relay the status of all claim submissions
- Be the point of contact between the law firm and medical provider by managing needs, issues, questions, and concerns of the patient
- Working a patient’s treatment from start to finish – from opening the file, managing the case, client communication, handling medical records and treatment, and finalizing the patient’s treatment
- Responsible for analyzing claims information to determine eligibility in the dispute resolution process in accordance with established federal regulations and company policies and procedures.
Senior Patient Care Coordinator
Alliance Recovery Center
02.2017 - 03.2019
- Verify patient insurance benefits, explain benefits to patients, obtain authorizations
- Managed prior authorizations, ensuring timely medication delivery and accurate insurance verification
- Created and maintained patient records, ensuring data accuracy and compliance with regulations
- Assessed patient treatment needs, coordinating care plans that matched clinical requirements
- Educated families on services and insurance benefits, enhancing patient understanding and satisfaction
- Facilitated intake processes, including benefits verification and financial assistance, improving patient access to care
- Spearhead innovative projects, driving substantial improvements in team productivity
- Collaborate effectively to solve complex challenges and deliver impactful results
- Optimized prior authorization processes, reducing medication delivery times and enhancing insurance verification accuracy for improved patient care
- Implemented a robust patient record management system, ensuring data integrity and regulatory compliance while streamlining information retrieval
- Conducted comprehensive patient assessments, developing tailored care plans that aligned with clinical requirements and individual needs
- Trains new employees in the company’s customer service policies, procedures, and best practices
- Organizes and oversees the schedules and work of assigned staff
- Conducts performance evaluations that are timely and constructive
- Handles discipline and termination of employees as needed and in accordance with company policy
- Collects, interprets, and assesses information regarding the patient’s prescribed specialty medication and associated health conditions while maintaining high-quality patient care and customer service.
Senior Patient Care Coordinator & Health Care Claims
Southwell Center for Healing and Wellness
03.2014 - 01.2017
- Identify and correct discrepancies in claims
- Manage patient claims and monitor patient progress through treatment
- Listen to clients’ concerns and providing counseling or intervention as required
- Review and process medical claims to ensure they are legitimate, accurate, and eligible for reimbursement
- Work to determine if payments are due and follow up to ensure procedures took place and claims are not fraudulent
- Working a patient’s treatment from start to finish – from opening the file, managing the case, client communication, handling medical records and treatment, and finalizing the patient’s treatment
- Following up with treatment status, communicating with insurance companies, other medical providers, pharmacy, medical supply companies
- Verify patient eligibility, contact other healthcare providers to ensure the accuracy of medical records, and assign clinical codes via classification
- Be the point of contact between the patient, caregiver, and medical provider by managing needs, issues, questions, and concerns of the patient
- Resolved procedure authorizations promptly, improving patient satisfaction and workflow efficiency
- Verified insurance eligibility, ensuring accurate billing and reducing claim rejections
- Educated patients on pre-appointment preparations, enhancing their experience and compliance
- Managed patient records and administrative tasks, maintaining data accuracy and organization
- Scheduled specialty appointments, optimizing clinic operations and patient access to care
- Led patient care coordination team, fostering interdepartmental collaboration to enhance treatment plans and improve patient outcomes
- Streamlined appointment scheduling process, reducing wait times and increasing patient satisfaction rates substantially
- Provided compassionate support to patients and families, ensuring clear communication of treatment options and care plans
- Implemented a new patient feedback system, leading to targeted improvements in service delivery and care quality
- Managed complex patient records with meticulous attention, ensuring accurate documentation and compliance with healthcare regulations
- Interacts with members by performing member outreach telephonically or through home-visits and documents the plan for care/services of activities
- Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed
- Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plan
- Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure
- Trains new employees in the company’s customer service policies, procedures, and best practices
- Organizes and oversees the schedules and work of assigned staff
- Conducts performance evaluations that are timely and constructive
- Handles discipline and termination of employees as needed and in accordance with company policy.
Dental Front Office Coordinator
Georgia Dental Practice
03.2013 - 04.2015
- Managed patient payments and processed insurance claims, ensuring accurate and timely transactions
- Communicated effectively with patients via phone, email, and text, enhancing patient satisfaction
- Assisted with insurance verification and explained benefits clearly, improving patient understanding
- Presented treatment plans and payment arrangements, facilitating informed patient decisions
- Audited accounts and pending claims for the next day's schedule, ensuring readiness and efficiency
- Coordinated front office operations, streamlined patient scheduling, and enhanced communication between staff and patients, improving overall practice efficiency.
Healthcare Scheduler & Patient Care Concierge Team lead
Drive Thru urgent care
05.2011 - 02.2014
- Managed patient scheduling and registration, ensuring accurate data entry and timely appointments
- Led a team of Front Desk Associates, training new hires and maintaining high service standards
- Verified insurance details, managed prior authorizations, and collected payments, improving billing accuracy
- Coordinated with referring physicians for medical records, ensuring complete documentation before visits
- Managed patient inquiries and confirmed appointments, enhancing patient satisfaction and clinic efficiency
- Led healthcare scheduling team, optimizing patient flow and reducing wait times
- Implemented efficient systems, enhancing overall care quality and patient satisfaction
- Coordinated with medical staff to ensure seamless patient experiences
- Fostered teamwork, improving communication and operational efficiency across departments
- Pioneered new patient concierge services, elevating care standards
- Developed creative solutions to streamline processes and enhance patient comfort and convenience
- Managed complex scheduling systems with precision, ensuring optimal resource allocation
- Maintained meticulous records, contributing to improved patient care continuity
- Provided compassionate support to patients, addressing concerns and facilitating smooth care transitions
- Mentored team members, fostering a culture of empathy and excellence.
Referral Coordinator/Front Office Coordinator
Atlanta Medical
03.2009 - 02.2011
- Receive and review incoming referrals from healthcare providers or agencies
- Verify that the referral information is complete, accurate, and meets the necessary criteria for assessment and evaluation
- Assess the urgency and priority of each referral based on established guidelines or protocols
- Verified pre-certifications and referrals for procedures, reducing patient treatment delays
- Collaborated with clinical staff to gather information, ensuring accurate precertification requests
- Tracked and monitored authorizations, maintaining timely patient care
- Processed incoming referrals, improving patient access to healthcare services
- Maintained HIPAA compliance, safeguarding patient confidentiality
- Implemented robust insurance verification protocols, minimizing treatment delays and improving overall patient experience
- Fostered strong relationships with specialists, optimizing appointment scheduling and increasing patient access to critical healthcare services
- Served as the primary point of contact for patients, addressing inquiries and providing clear referral information to boost satisfaction rates
- Developed and maintained stringent HIPAA-compliant procedures, safeguarding patient confidentiality throughout all referral activities.
Intake Coordinator (DME)
Durable Medical Supply
08.2007 - 02.2009
- Interviewed patients, obtained demographic and clinical information, ensuring accurate records
- Assisted patients with scheduling, reducing appointment no-shows through personalized plans
- Coordinated referral information with Intake Specialist RN, ensuring seamless communication
- Verified insurance coverage, updated patient information, and processed billing inquiries
- Provided clear explanations of imaging procedures, addressing patient concerns and ensuring comfort
- Streamlined DME intake process, reducing processing time and improving accuracy
- Implemented data-driven strategies for efficient patient care coordination
- Optimized insurance verification procedures, leading to faster claim approvals and increased patient satisfaction
- Consistently met or exceeded intake targets
- Fostered strong relationships with healthcare providers, ensuring seamless communication and timely delivery of medical equipment to patients in need
- Meticulously managed patient records and insurance documentation, maintaining compliance with HIPAA regulations and reducing errors in the intake process.
Insurance Verification Specialist
Healthy Minds
06.2005 - 07.2007
- Processed patient and insurance payments, ensuring accurate application and documentation
- Communicated financial responsibilities to patients, improving understanding and compliance
- Verified insurance benefits via multiple channels, ensuring compatibility with healthcare programs
- Reviewed schedules for accurate billing and insurance information, enhancing visit preparedness
- Secured referrals from primary care offices promptly, streamlining patient care processes
- Streamlined insurance verification processes, reducing claim processing time and enhancing accuracy
- Implemented data-driven solutions for efficient workflow management
- Optimized patient eligibility checks, leading to a substantial decrease in claim denials
- Collaborated with cross-functional teams to improve overall insurance verification efficiency
- Meticulously reviewed and verified insurance information, ensuring compliance with policies and regulations
- Maintained accurate records for seamless claims processing
- Determined coverage, completed eligibility verification, identified discrepancies, and applied all cost containment measures to assist in the claim adjudication process
- Coordinated responses for routine phone inquiries and written correspondence related to claim processing issues
- Routed and triaged complex claims to Senior Claim Benefits Specialist
- Proofed claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis, and pre-coding requirement.
Education
Bachelor of Science - Healthcare Adminstration
Southern New Hampshire University
Hooksett, NH07.2026
Some College (No Degree) -
DeVry University
Decatur, GASome College (No Degree) -
Middle Georgia College
Cochran, GAHigh School Diploma -
Newton High School
Covington, GA05.2006
Skills
- Five-star customer service
- Excellent organizational skills
- Appointment Scheduling
- Communication Skills
- Multitasking Abilities
- Excellent Communication
- Adaptability and Flexibility
- Patient Advocacy
- Effective Communication
- Analytical Skills
- Process Improvement
- HIPAA Guidelines
- Organizational Skills
- Patient education and counseling
- Attention to Detail
- Problem-solving abilities
- Interpersonal Skills
- Excellent communication and interpersonal skills
- Strong attention to detail and organizational abilities
- Ability to multitask and prioritize tasks effectively
- Possesses a strong customer service focus
- Able to generate, maintain and demonstrate a friendly, enthusiastic and positive attitude
- Experience with EPIC, ECW, DENTRIX and other EHR systems, and/or ability to learn and master practice’s scheduling systems
- Proficient computer skills, including knowledge of electronic medical records systems
- Has leadership that celebrates team members for delivering WOW patient experiences!
Personal Information
Title: Healthcare Admin Professional
Timeline
Senior Care Coordinator
Ennoble care
04.2021 - 08.2024
Senior Healthcare Claims Specialist
North Atlanta Primary Care Duluth
03.2019 - 03.2021
Senior Patient Care Coordinator
Alliance Recovery Center
02.2017 - 03.2019
Senior Patient Care Coordinator & Health Care Claims
Southwell Center for Healing and Wellness
03.2014 - 01.2017
Dental Front Office Coordinator
Georgia Dental Practice
03.2013 - 04.2015
Healthcare Scheduler & Patient Care Concierge Team lead
Drive Thru urgent care
05.2011 - 02.2014
Referral Coordinator/Front Office Coordinator
Atlanta Medical
03.2009 - 02.2011
Intake Coordinator (DME)
Durable Medical Supply
08.2007 - 02.2009
Insurance Verification Specialist
Healthy Minds
06.2005 - 07.2007
Bachelor of Science - Healthcare Adminstration
Southern New Hampshire University
Some College (No Degree) -
DeVry University
Some College (No Degree) -
Middle Georgia College
High School Diploma -
Newton High School
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