Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

SONYA SHINE

Converse

Summary

Strategic and results-driven healthcare executive with 10+ years of expertise in insurance claims management, patient services, and regulatory compliance across major healthcare organizations. Proven track record in leading cross-functional teams, streamlining clinical workflows, and maximizing revenue performance, highlighted by a national revenue record at Medtronic. Adept at navigating complex payer systems, Medicare/Medicaid regulations, and DME processes. Strong foundation in medical terminology, healthcare data analysis, patient intake, and provider relations. Holds a Bachelor of Science in Health Science, and multiple health care certifications.

Overview

26
26
years of professional experience
1
1
Certification

Work History

Patient Intake Advocate II Remote

Inogen
07.2024 - Current
  • Assessed patient eligibility for oxygen onboarding based on clinical criteria and payer guidelines.
  • Tracked and reviewed medical documentation from physicians, ensuring compliance with CMS standards.
  • Processed physician orders and patient payments through Bright Tree for seamless intake coordination.
  • Interpreted chart notes and 6-Minute Walk Test outcomes to validate medical necessity.
  • Exceeded monthly intake and conversion targets through proactive case handling strategies.
  • Supported urgent ER-related oxygen equipment requests, demonstrating reliability and responsiveness.

Licensed Agent (BCBSLA MAQ) Remote

HEALTH PLAN ONE
09.2023 - 07.2024
  • Drove revenue growth through strong relationship-building and effective upselling techniques.
  • Managed accounts, consistently exceeding sales targets to boost profitability.
  • Scheduled client appointments, establishing rapport through clear communication.
  • Prioritized client satisfaction, leading to high retention rates.
  • Leveraged upselling expertise to maximize revenue opportunities.
  • Supported team members, fostering a collaborative work environment.
  • Generated detailed sales reports and analyzed data for strategic decision-making.
  • Oversaw all contracts related to Medicare.

Senior Diabetes Processor Specialist III

Medtronic
06.2017 - 09.2023
  • Reduced errors through meticulous documentation review and attention to detail.
  • Enhanced team collaboration by sharing best practices for efficient processing techniques.
  • Maintained accurate records, ensuring timely completion of all necessary paperwork.
  • Entered data into tracking system and filed documents according to established procedures.
  • Analyzed processor data, developing insight reports for management review.
  • Submitted pre-authorizations for pharmacy and DME products, ensuring compliance with regulations.
  • Facilitated patient transitions between care levels, ensuring continuity of services.
  • Implemented process improvements for a faster turnaround time, and trained seven new hires to enhance team productivity.

Senior Dental Benefit Advocate II

United Health Care
10.2014 - 09.2016
  • Resolved processed dental claims accurately and ensured compliance with insurance policies.
  • Reviewed and adjusted claims to achieve timely resolutions with minimal errors.
  • Advised appeal department on discrepancies to enhance processing efficiency.
  • Facilitated communication among dentists, staff, and members for one-call conflict resolutions.
  • Delivered exceptional customer support, fostering loyalty through exceeding service expectations.
  • Maintained knowledge of service and policy changes via continuous training.
  • Demonstrated strong problem-solving skills in managing complex customer situations.
  • Assisted cross-functionally with provider relations per CMS guidelines.

IT Help Desk Specialist & PBM Representative

WEST CORPORATION - OPTUM RX PHARMACY
06.2010 - 07.2014
  • Delivered exceptional customer support at West Corporation, achieving lowest Average Handling Time in 2014.
  • Utilized Iris software for prompt resolution of customer inquiries, ensuring high satisfaction and retention.
  • Applied analytical skills to review pharmacy claims using RX Claims and RX HD software for compliance.
  • Completed ongoing training to stay updated on product and policy changes within pharmaceutical industry.
  • Submitted appeals and grievances forms, exercising discretion to escalate issues when necessary.
  • Assisted team members in facilitating successful customer interactions, enhancing teamwork and leadership.
  • Managed complex customer inquiries and collaborated with internal departments for timely resolutions.

Manager

LOW COST SMOKE SHOP
04.1999 - 01.2009
  • Recruited and trained personnel, making key promotion and termination decisions as needed.
  • Supervised 30 staff involved in sales, inventory management, and cash reconciliation.
  • Monitored sales activities to ensure exceptional customer service satisfaction.
  • Guided staff on handling complex sales negotiations effectively.
  • Scheduled work shifts and duties for team members efficiently.
  • Analyzed consumer demand to select appropriate merchandise types and quantities.
  • Developed pricing strategies aligned with profitability goals.
  • Conducted stock inventories and reordered supplies as necessary.
  • Inspected merchandise for accurate pricing and proper display presentation.
  • Prepared budgets, authorized payments, and managed returns processes.
  • Compiled inventory and sales data for comprehensive reporting.
  • Managed opening and closing procedures, reconciling sales, and securing cash deposits daily.
  • Served as corporate vendor liaison to maintain supply chain integrity.
  • Collaborated with executives to devise strategies boosting sales and market presence.
  • Identified and recommended a new store location achieving highest revenue in the chain.

Education

Bachelor of Science - Health Science

Western Governors University
Salt Lake City, UT
08-2025

Some College (No Degree) - General Education, Nursing

Saint Phillips College

High School Diploma -

GOOD WILL HIGH SCHOOL

Skills

  • Executive Leadership & Team
  • Claims Processing & Medical Review
  • Durable Medical Equipment (DME) Coordination
  • HIPAA, Fraud Waste & Abuse Compliance
  • Insurance Eligibility & Benefits Verification
  • Medicare, Medicaid, Commercial Payers
  • Provider Relations & Care coordination
  • Prior Authorizations
  • Intake Operations & Patient Experience
  • Project management
  • Payer Dispute & Appeals Resolutions
  • Cross-functional collaboration
  • Technical integration
  • Training, Coaching & Performance Metrics
  • Provider data services
  • Healthcare codes (HCPCS, DX & ICD-10 coding)
  • Prescription claims management (Rx, Rx HD)
  • IT Help Desk
  • CRM Tools: Salesforce, Centricity, Iris, Rx HD
  • Microsoft Office skills

Certification

  • St. Philips College, Pharmacology/Medical, Medication Administration, LVN Clinical Training
  • TDI: Life, Health/HMO, License: License # 2949250
  • AHIP: 2024 Medicare + Fraud, Waste and Abuse
  • Real Estate License: License # 820899
  • Red Cross: CPR
  • Medical Terminology

Timeline

Patient Intake Advocate II Remote

Inogen
07.2024 - Current

Licensed Agent (BCBSLA MAQ) Remote

HEALTH PLAN ONE
09.2023 - 07.2024

Senior Diabetes Processor Specialist III

Medtronic
06.2017 - 09.2023

Senior Dental Benefit Advocate II

United Health Care
10.2014 - 09.2016

IT Help Desk Specialist & PBM Representative

WEST CORPORATION - OPTUM RX PHARMACY
06.2010 - 07.2014

Manager

LOW COST SMOKE SHOP
04.1999 - 01.2009

Bachelor of Science - Health Science

Western Governors University

Some College (No Degree) - General Education, Nursing

Saint Phillips College

High School Diploma -

GOOD WILL HIGH SCHOOL

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