Shonika L. Mayfield
Charlotte,NC
Summary
A Medical customer service professional with twenty years of customer service experience with nine years of that experience being in the medical field. Expertise in intrapersonal and interpersonal communications with call center customers and clients, medical terminology and coding, problem solving, interacting with health insurance companies, Administering Medicare and Medicaid authorizations protocols, automobile insurance benefits (PIP), third-party payer practices and guidelines, precertification and referral management, CAS/CCP2 skilled, familiar with HIPPA rules and regulations, Microsoft family of products, and Medisoft program including but not limited to Excel, Word, and Access. Resourceful Customer Service Representative known for high productivity and efficient task completion. Specialized in communication, problem-solving, and time management skills, ensuring smooth operations in customer service environments. Excel in listening, empathy, and patience, which are crucial for addressing customer needs effectively and building positive relationships.
Overview
11
11
years of professional experience
Work History
Risk Adjustment Representative II
Humana, Inc.
Charlotte, USA
06.2016 - Current
- Travels (90%) to provider offices within the region and scans medical records into a secure system
- Independently schedules appointments and medical office visits in a timely, efficient manner while meeting all deadlines
- Follows HIPAA codes and regulations and Humana’s confidentiality agreement while securing documentation
- Use of Microsoft office products including Word, Excel, and scanning programs to complete tasks
- Interacts with different medical office staff’s daily to complete workload
- Team player while working independently
- Focused and detail-oriented in continuously new environments
- Request clinical information from providers/facilities
- Create and send out written correspondence
- Make outbound calls to engage providers to verify clinical information/discharge date and admission status through medical records request
- Document calls and attach clinical information received
- Creation and distribution of medical record correspondence
HCPR Customer Care Specialist
Humana, Inc.
Louisville, USA
08.2013 - 06.2016
- Processes Prior Authorizations via inbound calls to Humana Clinical Pharmacy Review
- Communicates with members and/or providers to verify clinical information
- Facilitates and works collaboratively with provider groups on Medicare Senior Products
- Gives the “Perfect Experience” for Members and Provider by providing positive customer service
- Researches, analyzes and resolves customer inquiries by using established best practices
- Documents confidential, clinical information received during calls
- Makes outbound calls to members and/or providers to gather clinical information for the review process
- Presents Humana’s products and services to customers, providers and employers via inbound and outbound calls
Education
Associate’s - Health Information Management
Daymar College
Louisville, KY01.2006
Skills
- Scheduling
- Account updating
- Complaint resolution
- Task prioritization
- Call escalation
- Tracking complaints
- Verbal and written communication
- Retail sales customer service
- Conflict resolution
- Money handling
- Microsoft Excel
- Skype
- Brand representation
- Problem resolution
- Follow-up skills
- Shipping and logistics
- Call center operations
- Microsoft outlook
- Delivery transport
- Key holder experience
- Empathy and patience
- Credit card payment processing
- Customer service
- Heavy lifting
Accomplishments
- S.T.A.R Award 4 years
Timeline
Risk Adjustment Representative II
Humana, Inc.
06.2016 - Current
HCPR Customer Care Specialist
Humana, Inc.
08.2013 - 06.2016
Associate’s - Health Information Management
Daymar College