Teanna Shuler
Molina Healthcare
Moncks Corner,SC
1
Certification
15
years of professional experience
Detail-oriented case processing, eligibility verification, and administrative professional with over 7 years of experience evaluating documentation, verifying eligibility requirements, maintaining compliance with regulatory standards, and supporting client-focused service operations.
Demonstrated success in reviewing records, resolving discrepancies, coordinating with stakeholders, and ensuring accurate and timely determinations. Strong background in healthcare administration, insurance verification, and confidential records management, with a commitment to quality, accuracy, and exceptional customer service.
Work History
Care Review Processor
3 Years 11 Months- Maintained HIPAA compliance in healthcare data systems.
- Collaborate with case managers, providers, and internal stakeholders to verify information, resolve discrepancies, and support timely case determinations.
- Analyze member records and supporting documentation to ensure accurate processing and adherence to established policies.
- Maintain detailed electronic records while safeguarding confidential information and meeting quality standards.
- Conducted detailed reviews of supporting documentation to verify eligibility criteria and ensure accurate case outcomes.
Front Office Receptionist
1 Year- Served as the primary contact for patients, greeting visitors and managing appointment scheduling in automated systems.
- Resolved patient inquiries, billing questions, and medical record requests while maintaining professionalism and empathy.
- Maintained ongoing communication with clients to explain requirements, collect documentation, and support successful outcomes.
- Coordinated with physicians and staff to ensure clinic efficiency and positive patient experiences.
Medical Insurance Specialist
1 Year 10 Months- Resolved denied claims to support accurate billing and clinic revenue cycle operations.
- Assessed coverage criteria and coordinated with providers and insurance representatives to obtain accurate eligibility determinations.
- Maintained compliance with payer guidelines and documentation standards.
- Resolved complex claim and authorization issues through detailed research and policy review.
- Conducted client interviews and gathered information to assess account status and determine appropriate resolutions.
Collection Customer Service Representative
2 Years 2 Months- Conducted outbound calls to customers with overdue accounts.
- Employed various resources to identify customers who are difficult to contact.
- Collaborated with customers to develop effective payment plans for debt resolution.
- Resolved customer inquiries efficiently.
Key Holder
5 Years 9 Months- Managed store operations, supervised staff, and provided front-line customer service.
- Trained employees in time management, organization, and task prioritization.
Education
Skills
Eligibility Verification
Documentation Review
Case Processing
Regulatory Compliance
Records Management
Case management
Client Communication
Data Entry & Validation
Insurance Verification
Benefit Coordination
Problem Resolution
Quality Assurance
HIPAA Compliance
Time Management
Team Collaboration
QNXT
Certification
- Foundational Skills for Communicating About Health
- Medical Administrative Assistants and the Healthcare Team
Accomplishments
- Managed high-volume inbound and outbound client communications.
Timeline
Care Review Processor
Molina Healthcare
09.2022 - CurrentRead More
Front Office Receptionist
Charleston Thyroid Center
08.2021 - 08.2022Read More
Medical Insurance Specialist
C.A.B
10.2019 - 08.2021Read More
Collection Customer Service Representative
C.A.B
08.2017 - 10.2019Read More
Key Holder
Charlotte Russe
11.2011 - 08.2017Read More
Stratford High School
Read More