Shy-Anne Mcleod
Brooklyn,USA
Summary
My name is Shy-Anne Mcleod and I have over 7years customer service experience, I am Microsoft efficient and I have experience working with EMR systems as well. Also I have experience with Medicaid and Medicare managed care plans, care management liaison and assisting with appeals and grievances as well.
Overview
9
9
years of professional experience
Work History
Provider Services Representative
MJHS
New York, NY
02.2024 - Current
- Assisting with claims, Billing and Appeals for providers.
- Assisting with Authorizations for providers servicing members.
- Assisting with Appeals and Grievances.
- Abiding by Medicaid, MLTC and CMS guidelines.
- Acting as a third party initiating communication with care management coordinators and team for assistance with inquiries in regard to the services they provide for the member.
- Record Keeping for Hospitalizations and Resumptions of Care.
- Documenting and referencing EMR systems, ie Guiding Care and Sales force.
- Assisting providers with contacting pre-certification nurses for Authorization approvals and request.
- Issuing Provider checks, providing the status of payment for claims and updating provider demographics.
- Linking Individual providers to facilities as requested with their Tax ID and NPI numbers
- Following all HIPPA Laws and Guidelines and confidentiality stipulations in place for confidentiality of providers and institutions that provide Medical services as well.
Secretary
FlexStaff Northwell Health
New York, NY
06.2023 - 01.2024
- All scripts obtaining and printing for current specialists services for incoming patients.
- Checking in Patients for needed appointments
- New Patient Registration for system records
- Abiding by all needed HIPPA laws needed to maintain ethics to ensure proper services to patients.
- Training with Soarian EMR systems which is used in all Northwell Health Facilities.
- Scheduling needed Telehealth appointments for patients as requested.
- Verification of patient insurance for all financial charges needed for patient services.
- Rescheduling and Cancellation of patient appointments if needed or requested.
- Working with Physicians directly to properly schedule appointments and assisting with time management for patient scheduling as well.
Customer Service Representative
Maximus
New York, NY
12.2022 - 03.2023
- Scheduling consumers to set up either a face to face evaluation to see if they are eligible for fair hearing
- Helping consumers family members become authorized Representatives for them if they are incapacitated in any way
- Helping consumers receive MLTC plan education and selection once they are approved for services.
- Performed data entry for customer information
- Set up client appointments
- Assisted customers with a warm and professional attitude
- Answered general questions
- Managed client records
- Provided policy and service information
Member Service Representative (Temp)
VNS Health
New York, NY
04.2022 - 10.2022
- Sent Authorizations for Durable Medical Equipment.
- Requesting for orders of Durable Medical Equipment
- HIPPA Verification for all member or member associates calling
- Data Entry
- Escalating transportation Equipment Care manager and all Manage Long term Care Inquiries
- Acting as a 3rd party to initiate contact to Care Managers for member that ask upon request.
Customer Service Representative
MMC Group (Left Due to Far Commute)
Staten Island, NY
01.2021 - 03.2021
- Maintained accurate customer profiles for EZ Pass accounts by updating information regularly. Processed payments swiftly for numerous EZ Pass accounts to minimize delays. Conducted plate matching to identify discrepancies and prevent billing errors. Coordinated replacement of defective EZ Pass devices, ensuring minimal disruption for users. Handled a high volume of calls while delivering prompt customer support. Prepared necessary actions for license suspensions due to unpaid tolls. Acted as a liaison between customers and New York City bridges and tunnels, improving service delivery.
NY Customer Service
AST Financial
Brooklyn, NY
10.2018 - 02.2019
- Comply with federal, state, company policies and procedures
- Operating telephone to answer, screen, or forward calls, providing information and taking messages
- File and maintain records; collect and document records being pulled and utilized
- Transmit information or documents to customers using mail, computer, and facsimile machines
- File and maintain records electronically and manually
Server/Hostess
TGIF'S RESTAURANT
New York, NY
10.2016 - 12.2016
- Received cash from customers and employees in payment for goods and services, and recorded amounts received
- Recorded amounts received and prepared reports of transactions
- Read and recorded totals shown on cash register tape and verified against cash on hand
- Operated cash register with peripheral electronic data processing equipment, for bar coding
- Provided fast and courteous service to patrons
- DEPARTMENT OF NEW YORK CITY PARKS AND RECREATION New York, NY
Education
High School Diploma -
World Academy For Total Community Health High School
Brooklyn, NY06.2013
Skills
- Customer service excellence
- Effective communication
- Time management
- Microsoft Office proficiency
- Medical terminology expertise
- Documentation analysis
- Data entry accuracy
- CSS knowledge
- ICD-10 familiarity
- Customer service
- Communication skills
- English
- Typing (5 years)
- Call center (5 years)
Timeline
Provider Services Representative
MJHS
02.2024 - Current
Secretary
FlexStaff Northwell Health
06.2023 - 01.2024
Customer Service Representative
Maximus
12.2022 - 03.2023
Member Service Representative (Temp)
VNS Health
04.2022 - 10.2022
Customer Service Representative
MMC Group (Left Due to Far Commute)
01.2021 - 03.2021
NY Customer Service
AST Financial
10.2018 - 02.2019
Server/Hostess
TGIF'S RESTAURANT
10.2016 - 12.2016
High School Diploma -
World Academy For Total Community Health High School