Shontay L. Cole

• Company Overview: Department of Defense -Tricare Prescription Monitoring Program (REMOTE- C2 SECURITY CLEARANCE) Works with senior care management team to support care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved.
  • Strengthened internal controls to minimize errors and maintaining integrity of disease management operations.
  • Obtained client medical history, medication information, symptoms, and allergies.
  • Performed medical records management, including filing, organizing, and scanning documents.
  • Collaborated with medical and administrative personnel to maintain patient-focused, engaging, and compassionate environment.

• Company Overview: Scottsdale AZ (REMOTE) Insurance verification, implementation of insurance billing procedures. Prior authorizations, in depth insurance knowledge. High volume data collection within the application of HIPAA practices and PHI, PHII procedures and processes.
• Inclusive to understanding and the application of insurance authorization procedures and medical, pharmacy benefit verification.
• Customer service-oriented position dealing with patients, professionals, facilities, and medical staff at high-level engagement.
• Volunteered for extra shifts during holidays and other busy periods to alleviate staffing shortages.
• Increased customer satisfaction by resolving complex issues and always providing exceptional service.

• Company Overview: Mesa, AZ (REMOTE/HYBRID) Extensive multitasking in a fast-paced environment handling, updating, and interpreting EMR, Intake, receiving and making large volume of calls both inbound and outbound. Application of billing practices; HCPC codes, ICD-10, HIPAA practices and PHI, PHII procedures and processes. Dispatching, routing, processing, and verification of new orders.
• Training of new hires and continual up training regarding patient sensitivity, product knowledge and health and safety regarding products and their medical usage and application.
• Customer service-oriented position primary focus on hospice and palliative patients, facilities, medical staff, and family using tact, professionalism, and sensitivity.
• Enhanced customer satisfaction by responding promptly to inquiries and addressing concerns professionally.
• Prioritized and managed multiple projects simultaneously, ensuring all met their deadlines and objectives without compromising quality.

• Company Overview: Phoenix, AZ (HYBRID) Primary support for daily EVV, payroll functions, knowledge for processes and communicating authorization and schedule changes to ensure coordination of service and client satisfaction. Coordination of Care Partner teams to; ensure fill rate expectations are met, research and resolve payroll and billing questions under direction from the Client Service Manager.
• Performed other duties such as scheduling, onboarding needs, record keeping and special projects as assigned, such as clerical and administrative responsibilities coupled with verification of employee required certifications and credentials; compliance with applicable legal requirements, standards, policies, and procedures including, but not limited to the Compliance Program: Code of Conduct, OSHA safety, HIPAA, and Documentation Standards.
• Handled escalated cases professionally while maintaining composure under pressure situations, demonstrating excellent problem-solving abilities under stressors common in the Client Services Coordinator role.
• Managed department call volume of 45-60 calls per day and coordinated department schedules to maximize coverage during peak hours.
• Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.

• Company Overview: Phoenix, AZ (ON SITE) Intake for wound care supplies, Ostomy, DME and Urological supplies. In conjunction with scheduling and full cycle billing for enteral and negative pressure wound therapy. Knowledgeable application of medical billing practices; ICD10, CTP and HCPC coding, coupled with insurance verification and authorizations.
• Application of expert customer service with both outside referrals, patients and other medical facilities and professionals during and throughout the coordination process.
• Maintaining strict confidentiality handling accounts, queues, and new cases within time sensitive constraints in a fast-paced and multi-tasking environment adhering to HIPAA guidelines and company policies.
• Meticulously documented patient medical information by utilization of best practices maintaining, case histories, and insurance details to facilitate smooth appointments and payment processing.
• Expedited critical cases through close coordination with clinical teams, reducing wait times for essential services. Resolved complex issues related to insurance authorizations or medical necessity quickly, minimizing delays in service provision and enhancing continuity of care.

• Company Overview: Scottsdale, AZ (ON SITE) Liaison between patients within and outside Honor Health network working directly with physicians and specialists to facilitate and expedite transfers within and outside of Honor Health network.
• Able to thrive in fast paced hospital and medical environment. Intermediate experience verifying insurance authorizations; daily audit and billing reports, bed placement solutions and scheduling, admitting, benefits verification and coordination of transportation assistance.
• Supported successful project completion by meticulously reviewing and updating project plans to reflect changing needs and objectives. Entered data, generated reports, and produced tracking documents.
• Prioritized and managed multiple projects simultaneously, ensuring all met their deadlines and objectives without compromising quality.
• Organized and maintained project documentation, enabling quick access to important information and facilitating smoother project transitions regarding appointment scheduling and itinerary coordination for both clients and personnel.

• Company Overview: Tempe, AZ (HYBRID) Resolving customer issues within required time limits and constraints regarding complaints and inquiries, re-evaluating electronic and manual claims, providing accurate and detailed information to members pertaining to their specific pharmacy benefits and, authorizations, plans, appeal(s) and grievance(s) policies and procedures, billing, and scheduling needs,
• Fast paced environment- handling 45-60 cases per day, account management maintaining confidentiality of sensitive documents through proper storage methods and restricted access control implementation per HIPAA & PHI, PHII laws and regulations.
• Provided quality clerical support through meticulous data entry, document management, email correspondence, and overseeing operation of office equipment.
• Trained new clerks on company procedures and software tools effectively contributing to their integration into the team.
• Utilized strong multitasking skills to manage multiple priorities and tasks, ensuring timely completion of each assignment.