SHLANDA WADE
Medical Billing Coding
Jackson,NJ
Summary
Experienced Clinical Administrative Coordinator skilled in managing clerical tasks, case management, and claims reviews in fast-paced healthcare settings. Recognized for exceptional organizational skills and meticulous attention to detail. Proficient in planning and communication. Ready to take on a new challenge with 30 years of relevant experience, seeking opportunities for growth and advancement.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Customer service agent
UNITED HEALTHCARE DNSP NAVIGATOR
03.2022 - Current
- Customer service agent which provides concierge and white-glove level service, removing burdens and providing end-to-end resolution for customers
- This includes, but is not limited to, clinical, financial decision support, behavioral support, claims inquiries, and more
- Respond to and own consumer inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, financial spending accounts, correspondence, OptumRx Pharmacy, Optum Behavioral Health and self-service options
- Conduct proactive research on assigned member accounts to identify service issues and inform member plan of navigation in coordination with clinical and/or non-clinical staff outreach
- Research includes, but is not limited to: Alerts, PCP on account, LIS, Medicaid, Medicare, Appeals, Billing, Claim Denials, PAs, Mail Order, Transportation
LHI CLINICAL ADMINISTRATIVE COORDINATOR
OPTUM SERVE
11.2020 - 03.2022
- Responsible for evaluating and approving Veterans Benefit Administration (VBA) Order Requests and determining the appropriate Disability Benefit Questionnaires (DBQs) to assign for identified health conditions specified on order requests per the contract requirements
- Review Compensation & Pension (C&P) request documents and claims file for completion of the claims file outline to facilitate LHI providers in location of pertinent information to ensure timely review and accurate completion of Disability Benefit Questionnaires (DBQs)
- Collaborate with various subject matter experts in the department to ensure system generated tasks are completed in a timely manner and within the quality standards
- Follow the established guidelines for monitoring and managing the prioritization of order related tasks in order to meet or exceed contractual requirements.
LEGAL CLERK ADVISOR
GANNETT
07.2016 - 07.2019
- Preparation of legal notices in print and online products
- Attention to detail accurately and quickly in a multi-deadline environment
- Strong telephone communication and customer service
- Effectively handled multiple projects in a timely manner
- High volume telephone communication.
PROOFREADER
PATHOLOGY SOLUTIONS
07.2016 - 07.2019
- Proofreads medical laboratory reports by detecting, marking and correcting grammatical, data entry, insurance or compositional errors
- Assisted with verifying client specific requests including staining protocols, proper triaging, and report style
- Determined insurance verification through Navinet
- Maintained adherence to all confidentiality mandates, including maintaining security and confidentiality of all data procedures and data system components.
Education
CERTIFIED MEDICAL ADMINISTRATIVE ASSISTANT MEDICAL BILLING/CODING -
RUTGERS UNIVERSITY
11.2020
CERTIFIED MEDICAL ASSISTANT -
MEDICAL CAREER INSTITUTE
11.2020
Skills
- ICD-10-CM /ICD-9 CPT coding
- ICD-10-PCS
- EKG
- Blood Pressure
- Injections& Immunizations
- Phlebotomy
- Vitals
- HIPAA Compliance
- OSHA
- Medical Coding/Billing
- Medical Scheduling/Records
- Patient Care
- Medical Imaging
- Office Skills
- Microsoft Word
- Excel
- PowerPoint
- Outlook
- Data Entry
- Dictaphone
- Call Center
- Claims Analyst
- Word Processing
- Analysis Skills
- Customer Service
- Quality Assurance
- Proofreading
- Claims Processing
- Invoice Processing
- Insurance Verification
- Medical coding knowledge
Certification
- CPR/AED Certification
- Medical Billing Certification
- Certified Medical Assistant
- Certified Notary Public
- Certified Medical Administrative Assistant
Timeline
Customer service agent
UNITED HEALTHCARE DNSP NAVIGATOR
03.2022 - Current
LHI CLINICAL ADMINISTRATIVE COORDINATOR
OPTUM SERVE
11.2020 - 03.2022
LEGAL CLERK ADVISOR
GANNETT
07.2016 - 07.2019
PROOFREADER
PATHOLOGY SOLUTIONS
07.2016 - 07.2019
CERTIFIED MEDICAL ADMINISTRATIVE ASSISTANT MEDICAL BILLING/CODING -
RUTGERS UNIVERSITY
CERTIFIED MEDICAL ASSISTANT -
MEDICAL CAREER INSTITUTE
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