Shyneria Monfort

• Processed and reviewed prior authorization requests for medical procedures, imaging, specialty referrals, and medications in compliance with Kaiser Permanente policies and insurance guidelines

• Verified member eligibility, benefits, and coverage to ensure accurate authorization decisions

• Coordinated with physicians, clinical staff, and external providers to obtain required clinical documentation

• Entered, updated, and maintained authorization records within electronic health record (EHR) systems

• Ensured timely turnaround of requests while meeting regulatory, quality, and productivity standards

• Provided excellent customer service by responding to provider and member inquiries regarding authorization status

• Provided leadership and guidance to team members, ensuring that tasks were completed on time and to a high standard.
• Assisted the manager in setting achievable goals for the team while monitoring progress towards them.
• Monitored team performance against targets, taking corrective action where necessary.
• Process payroll and attendance.
• Directed and supervised team of 22 employees in daily operations.

• Trained new staff in relevant processes and procedures.
• Provided support to junior staff during peak periods of workloads.
• Motivated staff through positive reinforcement techniques.
• Documented production levels and materials used to keep management informed.

• Delegation of daily work to assure that the providers needs are met.
• Handle escalation calls
• Review a minium of 60 calls per day for quality
• Provide one on one coaching to the staff to improve performance
• Attend daily client meeting to provide updates
• Provide monthly report updates to Supervisor, Manager and Clients

• Create Doctors profile in obtaining credentials to accept United Healthcare patients.
• Review Doctors records to assure that all necessary license are up to date.
• Follow Health Insure Portability and Accountability Act (HIPAA) law and guideline to protect clients confidentiality.
• Maintain a quality and performance score of 98.5 consistently