Shonta Wendel
Crowley,TX
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
10
10
years of professional experience
Work History
Reimbursement Case Manager
CareMetx
02.2024 - Current
- Acts as a single point of contact and voice for all providers and patients. Works as a patient advocate and always demonstrates compassion
- Serves as a patient advocate and enhances the caller/contact experience
- Coordinates access to therapies, conducts appropriate follow up and facilitates access to appropriate support services
- Manages case load depending on the parameters of the program
- Collects and review all patient information, to the degree authorized by the SOP of the program
- Validates completeness of all required information and provides assistance to provider and/or patient
- Provide guidance to physician office staff and patients on how to complete and submit all necessary program applications in a timely manner
- Determines patient’s eligibility and conducts patient enrollment activities (example patient assistance programs and copay assistance)
- Performs reimbursement related activities such as benefit investigations, prior authorizations, appeals, etc.
- Provide exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly
- Maintain frequent phone contact with patients, provider representatives, third party customer service representatives and pharmacy staff
- Provides reimbursement information to providers and/or patients
- Reports all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP)
- Coordinate with inter-departmental associates as necessary
- Work on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercise judgment within defined standard operating procedures to determine appropriate action
- Typically receives little instruction on day-to-day work, general instructions on new assignments
- Extensive knowledge of HIPAA regulations and follows all company policies
- Other duties as assigned - Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Reimbursement Specialist
Cornerstone Staffing
06.2023 - 02.2024
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Established and maintained relationships with insurance providers for productive communications.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Assisted patients in navigating complex insurance processes, leading to successful claim resolutions and reduced financial burdens.
- Collaborated with healthcare professionals to facilitate high-quality comprehensive care.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
Team Lead of Operations
HealthHelp
05.2022 - 06.2023
- Coached team members in techniques necessary to complete job tasks.
- Monitored team performance and provided constructive feedback to increase productivity and maintain quality standards.
- Supervised team members to confirm compliance with set procedures and quality requirements.
- Worked with team to identify areas of improvement and devised solutions based on findings.
- Conducted training and mentored team members to promote productivity, accuracy, and commitment to friendly service.
- Communicated KPIs outlined in annual plan to inform employees of expectations and deliverables.
- Conducted regular reviews of operations and identified areas for improvement.
- Developed effective improvement plans in alignment with goals and specifications.
- Generated reports detailing findings and recommendations.
- Developed and updated tracking spreadsheets for process monitoring and reporting.
Client Service Representative
HealthHelp
08.2021 - 05.2022
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Met customer call guidelines for service levels, handle time and productivity.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Promptly responded to inquiries and requests from prospective customers.
- Maintained up-to-date knowledge of product and service changes.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Utilized active listening skills to identify customer needs and provide appropriate solutions.
- Coordinated with operations staff to resolve service problems and boost client satisfaction.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
Benefits Verification Specialist
MMC Group Staffing
11.2020 - 08.2021
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Established contact with ordering physician's office to resolve any issues or to collect missing vital information.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
Senior Case Manager
Cardinal Health
08.2018 - 10.2020
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Monitored program performance and outcomes for successful delivery of services.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Set up and modified patient profiles to include current medications and insurance details.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Coordinated with physicians and insurance agency representatives for speedy resolution of prescription discrepancies.
- Provided consultations and answered inquiries from patients, healthcare professionals and physicians regarding drugs, potential side effects, and specified use.
Physician Office Representative
Baylor Scott & White Senior Center
11.2017 - 08.2018
- Checked patient insurance, demographic, and health history to keep information current.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Managed office bookkeeping with insurance billing and patient payments.
- Processed medical insurance claims and payments.
- Obtained payments from patients and scanned identification and insurance cards.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
- Invoiced patients accurately in line with charging guidelines.
- Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability.
- Adhered to strict HIPAA guidelines to protect patient privacy.
Pharmacy Customer Service Representative
Amerigroup Medicaid
08.2014 - 11.2017
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Handled customer inquiries and suggestions courteously and professionally.
- Resolved customer complaints using established follow-up procedures.
- Resolved third-party billing, computer system and customer service issues.
- Coordinated with physicians and insurance agency representatives for speedy resolution of prescription discrepancies.
- Identified issues, analyzed information and provided solutions to problems.
Education
Bachelor Of Business Administration - Business Management
The University of Phoenix
12.2013
Skills
- Insurance Verification
- Eligibility Verification
- Healthcare Terminology
- Reimbursement Management
- ICD-10 Coding
- Customer Service
- Reviewing Patient Information
- 10-Key Data Entry
Timeline
Reimbursement Case Manager
CareMetx
02.2024 - Current
Reimbursement Specialist
Cornerstone Staffing
06.2023 - 02.2024
Team Lead of Operations
HealthHelp
05.2022 - 06.2023
Client Service Representative
HealthHelp
08.2021 - 05.2022
Benefits Verification Specialist
MMC Group Staffing
11.2020 - 08.2021
Senior Case Manager
Cardinal Health
08.2018 - 10.2020
Physician Office Representative
Baylor Scott & White Senior Center
11.2017 - 08.2018
Pharmacy Customer Service Representative
Amerigroup Medicaid
08.2014 - 11.2017
Bachelor Of Business Administration - Business Management
The University of Phoenix
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