Trenice Robeson-Shephard
Trenton,NJ
Summary
I am pleased to submit my application for the Clinical Operations position. With more than 20 years of healthcare experience, including my current role as a Managed Care Coordinator with Horizon Blue Cross Blue Shield of New Jersey, I bring direct experience that closely aligns with the responsibilities of this position.
In my current role, I review service requests for completeness, collect and transfer non-clinical information, obtain structured clinical information from physicians and members, and perform initial screening of pre-certification requests using established scripts and workflows under clinical oversight. I also prepare, document, and route cases for clinical review and initiate callbacks and correspondence to clarify information and coordinate case completion.
My experience also includes serving as a liaison between members, physicians, and internal healthcare teams. I regularly work with sensitive healthcare information, respond to inquiries, gather information for escalated concerns, and follow established processes to support accurate and timely case resolution. These responsibilities have strengthened my communication, organization, documentation, and problem-solving skills.
My previous experience with Henry J. Austin Health Center further developed my knowledge of healthcare referrals, insurance authorizations, specialty-care coordination, patient scheduling, and collaboration with providers and healthcare organizations. Together with my background as a Certified Medical Assistant and National Registered Emergency Medical Technician, these experiences have provided me with a broad understanding of healthcare operations and patient needs.
I am especially interested in this opportunity because it builds upon the managed-care and clinical operations experience I have developed throughout my career. I would welcome the opportunity to continue contributing my knowledge of member and provider coordination, service-request review, case preparation, and healthcare processes while supporting the Clinical Operations team.
Thank you for your time and consideration. I would appreciate the opportunity to discuss my qualifications and how my experience can contribute to the success of the Clinical Operations team.
Sincerely,
Trenice Robeson-Shephard
609-672-5646 | trobe.shep@gmail.com Healthcare professional with 20+ years of experience across managed care, clinical operations support, medical referrals, insurance authorization, patient coordination, and healthcare administration. Currently serving as a Managed Care Coordinator with Horizon Blue Cross Blue Shield of New Jersey, with direct experience reviewing service requests, collecting and documenting clinical and non-clinical information, screening pre-certification requests, preparing cases for clinical review, and communicating with members and providers to resolve missing or incomplete information. Experienced in working within scripts, workflows, algorithms, and established procedures while maintaining accuracy, confidentiality, and member-focused service.
Overview
1
1
Certification
29
29
years of professional experience
Work History
Managed Care Coordinator
Horizon Blue Cross Blue Shield of New Jersey
Trenton, NJ
01.2015 - Current
- Review service requests for completeness, collect and transfer non-clinical data, and obtain structured clinical information from physicians and members for appropriate case handling.
- Perform initial screening of pre-certification requests received by telephone or correspondence, following established scripts, workflows, and procedures under clinical/supervisory oversight.
- Prepare, document, and route cases through the appropriate system for timely clinical review, ensuring required information is organized and accurately recorded.
- Initiate callbacks and correspondence with members and providers to clarify missing information, coordinate case completion, and support resolution of inquiries.
- Collect and collate information needed to address escalated phone and correspondence inquiries while maintaining professional communication with members and healthcare providers.
- Apply established scripts and algorithms to support authorization of services within the non-clinical scope of the Managed Care Coordinator role.
- Act as a liaison among members, physicians, and internal clinical/operational teams to facilitate accurate information exchange and case progression.
- Maintain accurate documentation of member and provider interactions and follow established processes for handling sensitive healthcare information.
Referral Clerk / Refugee Coordinator / Certified Medical Assistant / Referral Specialist
Henry J. Austin Health Center
Trenton, NJ
09.2001 - 03.2013
- Coordinated patient referrals and performed front-office and back-office healthcare functions in a community health setting.
- Obtained insurance authorizations from multiple carriers for radiology and nuclear medicine procedures, supporting timely access to specialty services.
- Scheduled uninsured patients with local hospitals and specialty-care facilities and helped coordinate services across healthcare organizations.
- Communicated and collaborated with providers and healthcare organizations to support continuity of care and referral completion.
- Provided patient support and healthcare administrative assistance while maintaining confidentiality, accuracy, and professional service.
UHCH Technician I
Albert C. Wagner Correctional Facility
Bordentown, NJ
11.2011 - 06.2012
- Provided healthcare support to incarcerated patients in a structured clinical environment.
- Followed established procedures and communicated patient needs appropriately within the healthcare setting.
Support Staff
Community Options
Princeton, NJ
07.2010 - 08.2012
- Provided on-site personal care assistance and support with activities of daily living.
- Provided supervision, structure, and individualized assistance while promoting safety, dignity, and independence.
National Registered Emergency Medical Technician / Patient Assistant Technician / Dispatcher
Invalid Coach Services
Hamilton, NJ
08.1997 - 12.1999
- Transported patients to hospitals while providing emergency medical care within EMT responsibilities.
- Assisted patients with wheelchair transportation to physicians offices and medical appointments.
- Organized, generated, and delegated patient transportation schedules, coordinating pickup and return assignments.
- Communicated with patients and healthcare facilities to coordinate safe and timely transportation.
Education
Medical Office Assistant Program -
Mercer County Health Occupational Technical School
Hamilton, NJEmergency Medical Technician -
Savannah Technical School
Pooler, GASkills
- Clinical Operations Support
- Managed Care Coordination
- Utilization Management Support
- Pre-Certification / Pre-Review Screening
- Service Request Review
- Case Preparation & Routing
- Member & Provider Communication
- Escalated Inquiry Support
- Referral Triage & Coordination
- Insurance Authorizations
- Clinical & Non-Clinical Data Collection
- Medical Documentation
- Care Coordination
- Healthcare Scheduling
- Patient Education
- Preventive Care Support
- Cross-Functional Collaboration
- HIPAA / Confidential Information
Certification
National Registered Emergency Medical Technician (experience), Certified Medical Assistant (experience), Medical Office Assistant training
TARGETED QUALIFICATIONS FOR CLINICAL OPERATIONS ROLE
- Direct managed-care experience reviewing service requests, screening pre-certification requests, and preparing cases for clinical review.
- Strong member/provider liaison experience with telephone and written correspondence, information gathering, clarification, and case completion.
- Healthcare referral and authorization background supporting specialty care, radiology, nuclear procedures, and uninsured patients.
- Experienced working within defined scripts, workflows, algorithms, policies, and clinical/supervisory oversight.
- Strong documentation, organization, communication, and problem-solving skills in healthcare environments.
Timeline
Managed Care Coordinator
Horizon Blue Cross Blue Shield of New Jersey
01.2015 - Current
UHCH Technician I
Albert C. Wagner Correctional Facility
11.2011 - 06.2012
Support Staff
Community Options
07.2010 - 08.2012
Referral Clerk / Refugee Coordinator / Certified Medical Assistant / Referral Specialist
Henry J. Austin Health Center
09.2001 - 03.2013
National Registered Emergency Medical Technician / Patient Assistant Technician / Dispatcher
Invalid Coach Services
08.1997 - 12.1999
Medical Office Assistant Program -
Mercer County Health Occupational Technical School
Emergency Medical Technician -
Savannah Technical School