SHIVAUN BATES
Aetna CVS Health
Willingboro,NJ
1
Certification
6
years of professional experience
Hardworking, highly motivated professional eager to lend combined knowledge and skills to enhance business performance. Operates well in both individual and team capacities, leveraging seasoned work ethic to quickly adapt to different processes and drive company objectives. Resourceful and results-driven with a passion for growth and efficiency to meet company needs and increase service value.
Work History
HEDIS Outreach Coordinator
1 Year 2 Months- Researched and identified discrepancies between medical record documentation and the information entered into the database, demonstrating proficient problem-solving capabilities.
- Maintained a high level of confidentiality when dealing with sensitive patient information, showcasing exemplary ethical conduct.
- Reviewed and analyzed medical records to ensure accuracy of data for HEDIS measurements, demonstrating excellent attention to detail.
- Resolved program implementation issues through effective problem-solving skills.
- Met performance goals and call center metrics in fast-paced performance setting.
- Communicated effectively with customers by actively listening, addressing their needs, and providing tailored solutions.
- Handled customer concerns during calls by adhering to established scripts.
- Navigated multiple computer systems and applications and utilized search tools to find information.
- Demonstrated ability to manage multiple tasks while remaining adaptable and flexible.
Medical Claims Research Specialist (Per -Diem)
2 Months- Utilized medical billing knowledge with usage of different platforms
- Researched denied or rejected claims for accuracy and took appropriate action to resolve discrepancies.
- Maintained up-to-date records of payments received from insurance companies, patients, and other sources.
- Assisted with accounts receivable by following up on unpaid claims within designated time frames.
- Answered all patient or insurance telephone inquiries pertaining to assigned accounts.
- Developed detailed knowledge of CPT coding system, insurance regulations, and medical terminology.
- Analyzed patient records and accurately coded diagnoses and procedures according to ICD-10 guidelines.
- Attended continuing education courses related to medical coding updates and industry trends.
- Negotiated payment arrangements with delinquent accounts in order to collect outstanding balances.
Clinical Claims Analyst
4 Years 7 Months- Partnered with other departments to coordinate efforts in resolving complex claims issues.
- Resolved customer inquiries regarding claim status in an efficient manner.
- Requested additional information and documentation to support and validate claim.
- Maintained up-to-date knowledge of relevant laws, regulations, industry trends, best practices, and current technologies.
- Developed a comprehensive knowledge of claims processing, insurance policies and procedures.
- Ensured compliance with state laws governing insurance contracts and settlements.
- Reviewed medical documentation for diagnosis accuracy prior to approving payment requests.
Education
Bachelor of Arts (B.A.) - Health Science
Associate in Science (A.S.) - Health Science/ Pre-Nursing
Skills
HEDIS Abstraction
Verbal communication
Liability and coverage
Healthcare procedures
Customer service
Teamwork and collaboration
Multitasking
Certification
Certified Release Of Information Specialist (CRIS)
Timeline
HEDIS Outreach Coordinator
Aetna CVS Health
03.2025 - 05.2026Read More
Medical Claims Research Specialist (Per -Diem)
Point 32 Health
01.2025 - 03.2025Read More
Clinical Claims Analyst
UnitedHealth Group
08.2020 - 03.2025Read More
Camden County College
Associate in Science (A.S.) from Health Science/ Pre-Nursing
Read More
Rutgers University-Camden
Bachelor of Arts (B.A.) from Health Science
Read More