Shenika Clyburn
Rock Hill
Summary
Case Manager with strong leadership experience at Cencora, focused on enhancing team performance and meeting service level agreements. Expertise in benefit verification and employee training, fostering collaboration and effective problem-solving. Dedicated to quality assurance, managing workflows to improve patient experiences and align with organizational objectives.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Case Manager/ Interim Program Manager- Dupixent MyWay
Cencora/ Lash Group
09.2019 - Current
- Run reports to ensure all service level agreements with the client were met.
- Effectively lead and oversee a team of 60.
- Ensure goals are met and employees are supported and motivated.
- Train and coach employees.
- Manage workflow and responsibilities to ensure all production, accuracy, and quality goals are achieved.
- Performing related duties as assigned, which include well defined services for complete patient journey (e.g., benefit verifications, Patient Assistance Program determinations).
- Handle appeal process for Dupixent prior authorization denials.
- Communicate with healthcare providers regarding patient journey.
Benefit Verification Specialist- Prolia
AmerisourceBergen /Lash Group
06.2016 - 01.2019
- Verify insurance benefits.
- Assisted with launching new drug program.
- Audit patient enrollment forms for accuracy and completeness.
- Verify diagnosis and procedure codes to ensure accuracy.
- Communicate with healthcare providers, payers, and pharmacy benefits managers to verify benefits and coverage.
- Manage workflow and responsibilities to ensure all production, accuracy, and quality goals are achieved.
- Performing related duties as assigned, which include well defined services (e.g., benefit verifications, Patient Assistance Program determinations).
- Researching and processing insurance claims, including resolving any claim denials or underpayment of claims.
- Establishing self as a regional expert on payer trends and reporting any reimbursement trends/delays (such as: billing denials, claim denials, pricing errors, payments, etc.).
Senior Customer Service Representative
Conduent/ Apple
08.2014 - 06.2016
- Assist customers with making online purchases.
- Manually placed different forms of payment into computerized system.
- Place orders for high end companies.
- Manage workflow and responsibilities to ensure all production, accuracy, and quality goals are achieved.
First Line Medical Agent
Connextions
11.2011 - 08.2014
- Assist customers with open enrollment.
- Researching and processing insurance claims, including resolving any claim denials or underpayment of claims.
- Provide advanced services to patients.
Customer Service Rep
Convergys
09.2009 - 06.2011
- Assist customers with navigation in car (OnStar).
- Manually placed different forms of payment into computerized system.
- Assist customers with diagnostic checks.
- Provides advanced services to customers.
Store Manager
McDonalds
04.2006 - 08.2009
- Provides advanced services to customers.
- Monthly inventory.
- Manage bank deposits and safe for each shift ending.
- Manage workflow and responsibilities to ensure all production, accuracy, and quality goals are achieved.
- Effectively lead and oversee team.
Education
Certified Nursing Assistant -
Nursing University Of South Carolina Lancaster
Lancaster, SC01.2014
High School Diploma -
Richland County School District
Columbia, SC01.2000
Skills
- Written and oral communication
- Organizational skills
- Time management
- Analytical thinking
- Team collaboration
- Goal orientation
- Problem-solving ability
- Microsoft Office proficiency
- Leadership skills
- Reporting expertise
- Training and development
- Salesforce proficiency
- Coaching and mentoring
- Adaptability
- Benefit verification
- Customer service
- Employee training
- Quality assurance
References
- Matthew Beatty, Program Manager-1, (704) 231-9770
- Bridgette Chambers, Program Manager, (803) 524-0326
Certification
- Nursing Assistant
Timeline
Case Manager/ Interim Program Manager- Dupixent MyWay
Cencora/ Lash Group
09.2019 - Current
Benefit Verification Specialist- Prolia
AmerisourceBergen /Lash Group
06.2016 - 01.2019
Senior Customer Service Representative
Conduent/ Apple
08.2014 - 06.2016
First Line Medical Agent
Connextions
11.2011 - 08.2014
Customer Service Rep
Convergys
09.2009 - 06.2011
Store Manager
McDonalds
04.2006 - 08.2009
Certified Nursing Assistant -
Nursing University Of South Carolina Lancaster
High School Diploma -
Richland County School District
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