SHEYLEA BROWN
CHARLOTTE
Summary
Experienced Benefits and Healthcare representative with a background in Human Services, Health Insurance, and Benefits. Demonstrated leadership, problem solving and analytical skills throughout career. Skilled in Medicaid billing, patient advocacy, and crisis management for accurate and timely data processing. Exceptional analytical skills for tailored solutions that enhance healthcare administration efficiency. Passionate about leveraging cultural competence and problem-solving abilities to drive innovative and cost-effective healthcare solutions. Strong understanding of HIPAA and other health regulations.
Overview
16
16
years of professional experience
Work History
CARE COORDINATOR
Accolade
08.2021 - Current
- Streamlined escalation processes for quicker issue resolution and improved member experience.
- Coordinated effectively with other departments such as Claims Processing, Medical Review, and Appeals to promote a seamless experience for beneficiaries navigating through various stages of their claims processes.
- Advocated for members'' rights within the healthcare system, working diligently to address concerns or barriers to care.
- Acted as a liaison between members, healthcare providers, and insurance companies to facilitate prior authorization approvals for necessary medications and health services.
- Served as primary point of contact for members benefits inquiries, resolving issues promptly and accurately.
HEALTH INSURANCE APPLICATIONS REP
Qualfon
10.2020 - 10.2021
- Provided exceptional customer service by handling high volumes of phone calls and email correspondence related to Medicare group enrollments.
- Enhanced members satisfaction by providing knowledgeable guidance on Medicare plan options and enrollment procedures.
- Managed high-volume workload effectively through prioritization and time management skills.
- Ensured compliance with HIPAA regulations through diligent management of confidential patient data.
CUSTOMER CARE ASSOCIATE
Conduent
09.2018 - 10.2019
- Addressed customer concerns and inquiries, providing information on toll rates, policies, and available payment options.
- Improved overall customer experience by actively listening to concerns and empathizing with complainants while seeking mutually beneficial solutions.
- Facilitated smooth transactions by guiding customers through required paperwork and payment processes accurately.
- Reduced errors in data entry by meticulously reviewing and validating information before submission.
ASSISTANT PROGRAM DIRECTOR
Services For The UnderServed
06.2013 - 06.2018
- Upheld the highest standards of integrity and ethical conduct in all Medicaid billing activities, ensuring compliance with state regulations and organizational policies.
- Updated director about project status, updates and concerns on weekly basis.
- Conducted regular performance evaluations for staff members, identifying areas for improvement and creating personalized development plans.
- Proactively identified potential barriers to effective service delivery, working closely with utilization management team to address issues before they impacted client outcomes.
- Developed individualized discharge plans to facilitate smooth transitions from residential treatment to supportive housing environments.
CASE MANAGER/MEDICATION COORDINATOR
Services For The Underserved
05.2009 - 06.2013
- Case Manager Duties:
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Provided crisis intervention support for clients experiencing emergencies, using appropriate techniques to de-escalate situations safely.
- Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources.
- Medication Coordinator Duties:
- Improved patient outcomes by providing comprehensive medication management and monitoring.
- Maintained detailed records of resident progress, daily routines, and medication administration for accurate reporting purposes.
- Managed medication administration processes, ensuring proper dosage, timing, and adherence to prescribed regimens for optimal therapeutic results.
Education
B.S. - HUMAN SERVICES
SUNY Empire State College
Brooklyn02.2018
HIGH SCHOOL DIPLOMA -
Hempstead High School
Hempstead06.2001
Skills
- Organizational skills
- Problem-solving
- Time management
- Crisis management
Timeline
CARE COORDINATOR
Accolade
08.2021 - Current
HEALTH INSURANCE APPLICATIONS REP
Qualfon
10.2020 - 10.2021
CUSTOMER CARE ASSOCIATE
Conduent
09.2018 - 10.2019
ASSISTANT PROGRAM DIRECTOR
Services For The UnderServed
06.2013 - 06.2018
CASE MANAGER/MEDICATION COORDINATOR
Services For The Underserved
05.2009 - 06.2013
B.S. - HUMAN SERVICES
SUNY Empire State College
HIGH SCHOOL DIPLOMA -
Hempstead High School
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