Shunna Boyd
Summary
Experienced Claims Specialist with a strong background in provider relationship management, negotiation, and healthcare claims processing. Demonstrated ability to meet and exceed departmental performance metrics and deliver effective communication. Proficient in initiating provider telephone calls, overcoming objections, and resolving negotiated claims
Overview
19
19
years of professional experience
Work History
Plan Building Specialist
Personify Health
Remote
04.2024 - Current
- Support Implementation and Account Management teams by consolidating information during new client implementation and/or renewal to ensure the accuracy of benefits.
- Translate benefits from ICD-10, HCPCS, CPT, CDT, and other insurance billing codes.
- Build out groups and upload benefit summary to website for members and faxback system for providers.
- Process Group terminations.
- Correspond with account managers, account coordinators, claims department, and other technical areas.
- Troubleshoot claims errors and refer escalated issues to team lead.
- Analyze complex benefit structures, translating insurance codes to create accurate SMART sheets, enhancing clarity for clients and internal teams.
Claims Specialist
Multiplan
Irving, TX
09.2019 - 04.2024
- Optimized healthcare savings by efficiently managing a high volume of claims, proposing agreements to providers, and achieving a 15% cost reduction
- Conducted comprehensive provider research to support cost savings, negotiated effectively to resolve counter offers, and complied with client guidelines
- Initiated and led successful provider telephone negotiations, establishing ongoing global agreements for future claims
- Updated and attentively maintained the provider database for reference, resulting in streamlined claims processing and a 20% reduction in errors
- Consistently surpassed quarterly departmental performance metrics by 10%
- Thoroughly documented all completed and outstanding claims, ensuring precision and accessibility
- Adjudicated claims in strict alignment with departmental policies, procedures, state regulations, accreditation standards, and other relevant rules
- Achieved production standards by processing an average of 31 claims per hour with an outstanding accuracy rate of 98.5% over each pay period
- Participated in organizational meetings to stay informed and connected
- Strictly followed organizational policies and procedures, upholding a high level of professionalism and ethical conduct.
Eligibility Research Representative
American Specialty Health
Southlake, TX
06.2016 - 08.2018
- Proficiently and accurately processed a variety of claims, including those in the medical and insurance sectors
- Conducted thorough reviews of incoming claims to ensure the presence of all necessary information
- Ensured the selection of the appropriate member and provider records for the processing of each claim
- Entered claims data into the Claims Processing System with precision
- Skillfully kept detailed records of both resolved and pending claims
- Adjudicated claims by adhering to departmental policies and relevant standards
- Achieved and consistently met production standards, meeting targets for claim processing rates and precision
- Validated data on scanned paper claims in accordance with established criteria
- Provided valuable support to fellow examiners when required
- Cultivated a culture of collaboration and teamwork among departmental personnel.
Assistant Director
Taresa's Daycare
Memphis, TN
09.2015 - 05.2016
- Collaborated with the Center Director to meet and exceed enrollment and accreditation goals.
- Assisted in maintaining the necessary documentation and processes for accreditation standards.
- Helped develop marketing strategies to attract new families to the center.
- Provided strong leadership and mentorship to the teaching staff to maintain high-quality education and care.
- Worked with the Center Director to ensure that teaching staff met state licensing requirements.
- Held regular meetings with parents to address their concerns, share updates, and build trust.
- Cultivated positive relationships with families, teaching staff, state licensing authorities, and community contacts.
Teacher
Klassy Kids Academy
Memphis, TN
08.2010 - 08.2015
- Created and implemented age-appropriate lesson plans and educational activities
- Established and upheld an organized and safe classroom environment
- Delivered instruction in various subjects and assessed student progress
- Maintained regular communication with parents regarding students' academic and social development
- Utilized a wide range of teaching materials and resources
- Offered additional support to students with individual learning needs
- Maintained meticulous records of student attendance, performance, and behavior
- Collaborated with colleagues, participated in team meetings, and engaged in professional development
- Enforced safety protocols and executed emergency procedures when necessary
- Cultivated a positive and inclusive classroom environment.
Receptionist
Graceland Nursing Center
Memphis, TN
08.2009 - 08.2010
- Oversaw the front desk and served as the initial point of contact for visitors and residents
- Welcomed visitors and directed them to appropriate areas or personnel
- Coordinated appointments for residents with healthcare professionals
- Maintained meticulous records, including visitor logs and appointment schedules
- Provided essential information to residents, visitors, and staff
- Managed incoming and outgoing mail and packages
- Offered administrative support, including data entry and clerical tasks
- Assisted in emergency procedures and facilitated notifications
- Resolved visitor and resident concerns and conflicts with professionalism
- Monitored security at entrances and access points
- Collaborated closely with administrative and nursing center staff.
Front Desk Attendant
24HR Fitness
Memphis, TN
12.2005 - 07.2009
- Managed and meticulously maintained an organized appointment diary, ensuring accurate scheduling and timely information delivery in response to customer inquiries and complaints
- Delivered exceptional customer service, resulting in a remarkable customer retention rate of 98%
- Proactively monitored security access and directed individuals to their destinations within the fitness facility
- Handled telephone calls and provided information and assistance as needed
- Administered sign-in and sign-out procedures, ensuring security and access control
- Ensured the cleanliness and organization of the front desk area, cultivating a welcoming and professional environment
- Assisted with various administrative tasks, including mail sorting, data entry, and support for bookkeeping functions
- Participated in the planning and coordination of facility events and promotions.
Education
High School Diploma -
Skills
- Data Entry
- Medical Billing
- Medical Coding
- Scheduling
- Medical Records
- Claims Auditing
- Communication
- Negotiation
- HIPAA Compliance
- Microsoft Office
- Windows
- Typing Speed: 45 WPM
- EHR/EMR Systems
- QNXT
- QICLINK
- Availity
Timeline
Plan Building Specialist
Personify Health
04.2024 - Current
Claims Specialist
Multiplan
09.2019 - 04.2024
Eligibility Research Representative
American Specialty Health
06.2016 - 08.2018
Assistant Director
Taresa's Daycare
09.2015 - 05.2016
Teacher
Klassy Kids Academy
08.2010 - 08.2015
Receptionist
Graceland Nursing Center
08.2009 - 08.2010
Front Desk Attendant
24HR Fitness
12.2005 - 07.2009