Shyneria Monfort
Stone Mountain,GA
Summary
Experienced professional in Credentialing, Customer Service and Insurance with strong analytical skills. A team player with a positive attitude that is very detail oriented. Proficient with medical, dental, vision and hearing claims and coverage. Motivated in growing with a company that is passionate about their mission and vision.
Overview
9
9
years of professional experience
Work History
Supervisor
Wipro (United Healthcare)
06.2021 - Current
- 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. Schedule weekly one on ones. Attend client meetings daily.
- Process payroll and attendance for 42 employees.
- Provide referrals for vision coverage per members insurance plans to providers.
- Review referrals and confirm that they aligns with their coverages.
- Provide prior authorization for required upcoming services.
- Collaborate with providers, to streamline the process for upcoming services.
- Generate prior confirmation or authorizations for upcoming appointments.
- Contact providers on behalf of the customer to assist with appointment scheduling or connect with internal Specialist for assistance.
- Assist providers, Health plans and members with inquiries related to members Benefits, claims and Lab orders.
Team Lead
Wipro (United Healthcare)
01.2020 - 06.2021
- 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.
- Welcome new Dental patients to health insurance plan. Review welcome packets and assist with any questions.
- Outreach to member's to ensure profile is up to date.
- Review dental coverage with members.
Quality Analyst
Wipro (United Healthcare)
01.2017 - 01.2020
- 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
- Provide daily and monthly report updates to Supervisor, Manager and Clients
- Coach, and create different SOPs to improve Quality scores.
- Train on new tools and updated based on staff changes.
Provider Credentialing Specialist
Wipro (United Healthcare)
01.2016 - 01.2017
- 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
Education
Medical Assistance
Everest Institute
Atlanta, GA06-2012
Skills
Eye Manager
Nice
Citrix
Agent WorkBench
Microsoft Office
Excel
ADP
National Database (NDB)
Webstation
Salesforce
Timeline
Supervisor
Wipro (United Healthcare)
06.2021 - Current
Team Lead
Wipro (United Healthcare)
01.2020 - 06.2021
Quality Analyst
Wipro (United Healthcare)
01.2017 - 01.2020
Provider Credentialing Specialist
Wipro (United Healthcare)
01.2016 - 01.2017
Medical Assistance
Everest Institute
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