Shundel Little
Orlando,FL
Summary
Analytical, versatile, and detail-oriented professional with over 5+ years in the healthcare insurance industry. I'm driven to resolve claims and achieve company standards. Builds and maintains professional and productive relationships. Proven experience investigating and resolving, health claims and appeals. Delivers professional and balanced customer service by providing skills to prioritize and multi-task in fast-paced working environment
Overview
11
11
years of professional experience
Work History
CASE MANAGER
AssistRX
Orlando, FL
05.2023 - Current
- Streamlined prescription requests (ERx) from providers, ensuring timely delivery of medications for patients.
- Processed and follow-up on 30+ applications for cancer patients
- Received over 50 incoming calls from patients and providers
CLAIMS SPECIALIST/PROVIDER SERVICE
Heathcare Staffing/Centene
Maitland, FL
04.2018 - 03.2021
- Reduced claim processing time by 10% through efficient precertification and referral processes.
- Provided an explanation of denied claims to providers
- Received over 80 calls a day from providers and members
- Assisted providers with pre-certification and referrals
- Maintained a quality score of 95% or higher
AUTHORIZATION SPECIALIST
SimondMed Imaging
Lake Mary, FL
08.2017 - 01.2018
- Obtained diagnostic imaging authorizations for providers, ensuring timely access to medical imaging services.
- Obtain the authorization by leveraging online platforms like availty and NIA, which increased authorization approval by 15%
- Successfully completed over 30 approved authorizations daily, exceeded my assigned quota.
MEDICAL AUTHORIZATION SPECIALIST
Florida Hospital
Altamonte Springs, FL
05.2016 - 08.2017
- Obtained medical authorizations from insurance companies, ensuring patients received appropriate medical care.
- Maintained accurate patients demographics, contributing to the flow of patient care.
MEMBER SERVICE REPRESENTATIVE
HealthFirst
Lake Mary, FL
02.2013 - 02.2016
- Resolved customer issues and basic claims for over 80 members daily, utilizing various computer systems.
- Achieved a high QA score of 98% or better due to providing great customers service
- Maintained accurate records of authorizations and payments for Child Health Plus accounts.
Education
PROGRAM- HR PEOPLE ANALYTICS -
UNIVERSITY OF MARYLAND GLOBAL
BALTIMORE, MD07.2024
DIPLOMA OBTAINED -
ATLANTIC HIGH SCHOOL
PORT ORANGE, FL06.1998
Skills
- ICD 10
- HCPCS/HIPPA
- Availity/NIA
- Excel
- Salesforce
- Excellent communication
- Analytical and problem-solving
- Conflict Resolution
- Medical Terminology
- Data Entry and Analysis
- Analytical Thinking
Hobbies and Interests
- Literature
- Traveling
- Pilates
Timeline
CASE MANAGER
AssistRX
05.2023 - Current
CLAIMS SPECIALIST/PROVIDER SERVICE
Heathcare Staffing/Centene
04.2018 - 03.2021
AUTHORIZATION SPECIALIST
SimondMed Imaging
08.2017 - 01.2018
MEDICAL AUTHORIZATION SPECIALIST
Florida Hospital
05.2016 - 08.2017
MEMBER SERVICE REPRESENTATIVE
HealthFirst
02.2013 - 02.2016
PROGRAM- HR PEOPLE ANALYTICS -
UNIVERSITY OF MARYLAND GLOBAL
DIPLOMA OBTAINED -
ATLANTIC HIGH SCHOOL