Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Suzanne Shelby

Managed Care Assistant II
San Jose,CA

Summary

To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.

Overview

22
22
years of professional experience
1
1
Certification

Work History

Managed Care Assistant II

Sutter Health
Mountain View, CA
08.2019 - Current
  • Review claim payments for accuracies
  • Enter referrals and process as per UM matrix work flow
  • Obtain clinical policies and benefits as needed for referrals
  • Knowledge of in network and in area providers for individual insurances
  • Collect data and send requests to insurance companies to obtain acute enrollee status
  • Research possible acute enrollee and DOFR items for recovery
  • Maintain and update auto authorization lists for multiple department use.

Managed Care Coordinator

Palo Alto Medical Foundation, PAMF
Mountain View, CA
09.2007 - 08.2019
  • Enter referrals requests from outside providers into PAMF records system (Epic)
  • Determine if providers/facilities are contracted with medical group and health plan
  • Obtain medical policies and benefit guidelines from individual health plans/CMS/MCG
  • Research possible acute enrollee issues and enter claim settings into Epic
  • Research claims to determine if retro referrals are required or a claim needs to be reprocessed
  • Enter CRMS's into EPIC to have insurances updated and providers entered into the system
  • Answer phone calls from our provider relations staff for escalated issues
  • Helped create processes and point person for our Sutter Health Plus HMO insurance within our division.

Patient Services Representative

Palo Alto Medical Foundation
San Jose, CA
08.2001 - 09.2007
  • Assisted patients in filling out check-in and payment paperwork.
  • Took copayments and compiled daily financial records.
  • Filed and maintained patient records in accordance with HIPAA regulations.
  • Built and maintained positive working relationships with patients and staff.
  • Verified insurance eligibility and coverage for patients.
  • Entered patient demographic and insurance data into electronic medical record system.
  • Handled customer service inquiries in person, via telephone and through email.
  • Provided exceptional customer service to patients, answering questions and addressing concerns.
  • Greeted and assisted patients with check-in procedures.
  • Helped address client complaints through timely corrective actions and appropriate referrals.

Education

No Degree - Medical Assistant

Institute For Business And Technology
Santa Clara, CA
05.2001 -

Skills

Multidisciplinary team collaboration

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Certification

Medical Assistant

Timeline

Managed Care Assistant II

Sutter Health
08.2019 - Current

Managed Care Coordinator

Palo Alto Medical Foundation, PAMF
09.2007 - 08.2019

Patient Services Representative

Palo Alto Medical Foundation
08.2001 - 09.2007

No Degree - Medical Assistant

Institute For Business And Technology
05.2001 -

Medical Assistant

11-1994

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Suzanne ShelbyManaged Care Assistant II