SHONNDA MCCULLOUGH
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Summary
Motivated Healthcare Claims Professional knowledgeable in healthcare management, hospital operations and regulatory compliance. Talent for overseeing multiple tasks while maintaining quality care. Hardworking and diligent with passion for patient advocacy. Committed to ensuring customer satisfaction by providing exceptional service and unmatched support.
Overview
29
29
years of professional experience
Work History
Claims Analyst
Kaiser Permanente
02.2023 - Current
- Analyze referrals and claims information for accuracy according to establish guidelines and provides education/feedback and reports
- Assist Claims Auditors with tracing sources of inaccuracies, reports and proposes remedial action to appropriate manager
- Prepare detailed analysis of claims activity and submit reports
- Works with Finance department and others as resource regarding all aspects of Outside Medical Claims
- Monitors and coordinate special transactions such as check adjustments and credits
- Formats and prepare statistical reports and work close with CAD to assist with financial analysis
- Approve outside referrals and verify with Chief of Service and or AAMD if need further approval
- Meet compliance deadlines with five-day turnaround time for completion of approved referrals
- Verify members benefit and coordinate referrals with Outside Contracted Providers.
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
Member Service Customer Service Representative Tier II
Kaiser Permanente
08.2014 - 02.2023
- Extensive experience and skill in customer service
- Member Service specialist responsible for providing members with detailed benefit clarification, knowledge of specific plan details, enrollment and dis-enrollment, payment processing for premium and deductible based cost shares
- Assists with Kp.org web technical support and navigation of multiple site resources
- Assists members with application process and explanation of different plan options, including Medicare skills
- Provides information in regard to open enrollment and special enrollment periods
- Assists member with confirming appointment information
- Responsible for providing accurate and thorough bill explanation, as well as service bill recovery when applicable.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
Customer Support Representative
AT&T
08.2012 - 08.2014
- Assists customer’s questions and concerns on all products and services offered by the Company through research and resolution using various tools and systems
- Processes credit applications and activate service
- Maintains appropriate records, prepares required reports, and updates customer accounts utilizes various systems and tools to initiate to assist and service customers.
- Managed escalated calls with professionalism, ultimately resolving complex issues to the satisfaction of both the client and company.
- Resolved customer complaints by distinguishing, prioritizing and reporting technical issues.
Customer Service & Sales Specialist
Bank of America
04.2012 - 08.2012
- Managed incoming calls from our small business credit card customers while developing a rapport to broaden our existing relationship
- Achieve monthly sales goals and maintain minimum call standards
- Following proper security verifications for every customer while minimizing fraud and maintaining customer satisfaction.
- Promoted new products and services to existing customers, driving revenue growth and satisfaction.
- Enhanced customer satisfaction by addressing and resolving complex issues promptly.
Testing Technician
AT&T
12.2006 - 11.2009
- Performed testing on data telephone, digital, fiber and Hi-cap systems
- Received trouble reports from customers and other work groups in connection with maintenance of complex special services including data circuits, multiwire circuits, fiber systems and Hi-cap systems.
- Streamlined data collection methods for faster analysis and decision-making, enhancing overall productivity.
- Provided technical support to the production team, resolving issues promptly and minimizing downtime.
Maintenance Administrator
AT&T
11.2000 - 12.2006
- Analyze mechanized loop test readings, interpret results and recommend action based on equipment and trouble description
- Request support from central office frame and field technicians, to make cable transfers, line equipment number changes and extensive testing to isolate trouble.
- Reduced downtime by efficiently coordinating maintenance tasks and prioritizing urgent requests.
- Managed maintenance schedules for multiple facilities, ensuring timely completion of all required tasks.
Directory Assistance Operator
AT&T
10.1995 - 11.2000
- Provide customers with directory information regarding business names, addresses and telephones numbers
- Suggest and check alternate spellings, locations, and/or listing formats to customers lacking details or complete information.
- Streamlined call handling processes for increased efficiency and reduced wait times.
- Participated in ongoing training initiatives to continually enhance product knowledge and service capabilities.
Education
Bachelor of Science - Business Administration in Healthcare Management
Colorado Technical University
Denver, CO07.2024
Associate of Science - Business Administration
Colorado Technical University
Denver, CO11.2022
Skills
- Claims
- Claims analysis
- Interpersonal and written communication
- Policy Interpretation
- Skilled in EPIC
- MS Office
- Customer service and support
- Computer Skills
- Active Listening
- Microsoft Office Suite
- Team Leadership
- Coverage Determination
- Healthcare Common Procedures Coding System (HCPCS)
- Benefits review
- Insurance policy coverage knowledge
- Payment Processing
- Regulatory Compliance
- Excellent Communication
- Multitasking
Timeline
Claims Analyst
Kaiser Permanente
02.2023 - Current
Member Service Customer Service Representative Tier II
Kaiser Permanente
08.2014 - 02.2023
Customer Support Representative
AT&T
08.2012 - 08.2014
Customer Service & Sales Specialist
Bank of America
04.2012 - 08.2012
Testing Technician
AT&T
12.2006 - 11.2009
Maintenance Administrator
AT&T
11.2000 - 12.2006
Directory Assistance Operator
AT&T
10.1995 - 11.2000
Bachelor of Science - Business Administration in Healthcare Management
Colorado Technical University
Associate of Science - Business Administration
Colorado Technical University
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