Shunte Lloyd
Orange,NJ
Summary
To obtain a challenging and sustainable career position in which my educational and work experiences can be utilized to assist in improving company operations as well as career growth. Authorized to work in the US for any employer
Overview
9
9
years of professional experience
Work History
Residential House Cleaner
Self Employed Services
Orange, NJ
01.2024 - Current
- Vacuumed carpets and upholstered furniture.
- Replaced sheets and pillowcases daily and used hospitality corners on beds to provide comfort for guests.
- Checked inventory for required supplies and made lists for needed cleaning products.
- Moved beds, sofas and small furniture to wipe down baseboards and remove dust and dirt from hard-to-reach areas.
- Inspected for damages to property that may have occurred during the cleaning process.
- Maintained a safe working environment by using appropriate cleaning supplies.
- Scrubbed kitchen counters, cabinets and backsplashes.
- Provided feedback on customer service issues to management team.
- Sanitized bathrooms including toilets, showers and tubs, sinks and countertops.
Utilization Management Coordinator
MetroPlus Health
New York, NY
01.2022 - 01.2024
- Receive service requests from providers and members via facsimile, provider portal, phone and mail
- Receive in-coming calls, address the caller’s needs (providers and members) and/or offer clarification on questions or concerns as related to policy & procedure and benefits
- Strive to provide first-call resolution to all callers
- Provide superior customer service to all providers and members
- Verify member eligibility and benefits utilizing the MIS system and/or ePACES.
- Create and/or complete an authorization shell, generating a reference number.
- Follow documented process flow and job aids to either process the authorization request to completion or direct request to clinical staff (Nurse or MD) for review.
- Initiate requests via phone/facsimile for supporting documentation to determine medical necessity of requested services
- Receive and process inbound correspondence to ensure it is associated with the correct member and contains adequate information for clinical review
- Refer to RN or MD as indicated
- Generate denial letters which relate to the member’s ineligibility for services when appropriate
- Follow guidelines for services which can be approved by the CMA under the direction of the Medical Director
- Generate approval letters for members and providers, where applicable, utilizing the system’s correspondence module, and selecting the correct letter template according to the members line of business.
- Accurately document and enter data in MIS system pertaining to the services requested, including correct member, provider and clinical information such as service dates, diagnosis codes, service codes
- Work efficiently and diligently and meet minimal required performance expectations and quality requirement
Practice Coordinator
Hospital Health Medicine TeamHealth
Edison, NJ
10.2019 - 03.2021
- Coordinated work activities and scheduling of medical, nursing and physical plant staff.
- Responsible for maintaining up-to-date knowledge of changes in coding guidelines or regulations impacting billing procedures.
- Reviewed invoices for accuracy prior to payment processing.
- Performed data entry into various systems including EHRs
HEDIS Coordinator
Centers Plan for Healthy Living
Staten Island, NY
10.2015 - 10.2019
- Outbound and Inbound Call Center
- Manage Members Care
- Outreach PCP Providers to receive Lab Reports and Progress Notes
- Data Entry using Microsoft Office
- Data Entry using CaseTrakker
- Schedule Members Wellcare Appointments
- Collect all HEDIS information from providers
- Enforce all HIPAA Privacy Laws
Education
High School Diploma -
Malcolm X Shabazz High School
Newark, NJ06.2007
Skills
- Epic
- Office Management
- Medical Office Experience
- EMR Systems
- Hospital Experience
- Insurance Verification
- Medical Records
- HIPAA
- Medical Scheduling
- HEDIS
- Utilization review
- Efficient time management
- Flexible scheduling
Education and Training
true
Timeline
Residential House Cleaner
Self Employed Services
01.2024 - Current
Utilization Management Coordinator
MetroPlus Health
01.2022 - 01.2024
Practice Coordinator
Hospital Health Medicine TeamHealth
10.2019 - 03.2021
HEDIS Coordinator
Centers Plan for Healthy Living
10.2015 - 10.2019
High School Diploma -
Malcolm X Shabazz High School