Yakesha Shropshire
Altamonte Springs,FL
Summary
Reliable professional with 20 years of experience in the medical field and a strong background in both medical and customer service. Demonstrated success in various medical settings, including medical practices, hospitals, nursing homes, healthcare call centers, and WFH remote work. Skilled in behavioral health, case management, utilization management, and medical administration. Exceptional communication and customer service abilities focused on delivering top-notch care and instilling confidence in patients and clients. Responsible for various reimbursement functions such as accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and refunds until accounts receivable issues are resolved. Proficient in speaking and assisting Area Business Managers/Sales Representatives with claim submissions from local providers.
Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
4
4
years of professional experience
Work History
ACE-Escalations Team (Eylea) & PAS (Novo Obesity)
AssistRx
Orlando, FL
07.2025 - Current
- Adapted quickly to changing demands and executed responsibilities effectively in fast-paced environments.
- Exhibited proactive, responsible work approach through independent follow-through on assigned tasks.
- Delivered clear, concise verbal updates and accurate written documentation through strong communication skills.
- Coordinated support for day-to-day operations, partnering with team members to maintain efficient execution and productivity.
- Coordinated end-to-end handling of complex customer escalations, driving timely resolution and satisfaction.
- Collaborated with cross-functional teams to streamline escalation processes and improve response times.
- Tracked customer unresolved issues and conducted follow-up communications until issue status was resolved.
- Investigated claim denial and delay issues, handled escalated customer concerns, and maintained empathetic, professional communication throughout.
- Worked independently and in team settings to support coordinated execution of responsibilities.
- Developed strong capability to quickly learn new skills and adjust approach in evolving situations.
Patient Access Consultant AR/Case Manager
Cencora (MMC Group Staffing Agency)
Orlando, FL
09.2024 - 02.2025
- Liaised with customers, management, and sales team to better understand customer needs and recommend appropriate solutions.
- Evaluated client needs and expectations, establishing clear goals for each consulting engagement.
- Called insurance companies to get precertification and other benefits information on behalf of patients.
- Med D Patient Assistance Program (PAP) Annual Reverification re-enrollment
- Pre-check assessment & eligibility for PAP, Federal Poverty Line (FPL), LIS/Extra Help, reimbursement activities, M3P attestation & OOP Max, and Copay Assistance
- Benefits Verification, Third-party Prior Authorization, Copay, deductible, and Quick Start
- Medicaid, Medicare, Private Payers, Veterans Affairs Healthcare (VA), & Tricare
- Reports all Adverse Events (AE) & Product Technical Complaints (PTC) related to drug therapy and pharmacy care
- Volunteered for the Outbound Call Team
- PSQA, data intake, and reporting missing information to the Health Care Provider
- Software Salesforce, MedConnect, CenterX, & Patient Plus.
Referral Specialist/NMCM Case Manager
AHF AIDS Healthcare Foundation
Orlando, FL
04.2024 - 07.2024
- Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.
- Obtained prior authorization for transportation, medical, housing, dental, and procedures.
- Referral Specialists contribute to AHF by conducting proactive outreach to clients by providing education and assisting with enrollment in the Ryan White eligibility program
- RS/NMCM Case Manager will work directly within the Care Management team and Healthcare Center to enroll newly diagnosed patients, patients lost to care, and clients currently in care by completing (RDA) Referral Determination Assessment
- Responsible for processing referral authorizations for clients with HIV/AIDS
- Assisting with referrals for needed medical services, pharmacy, housing, dental, and transportation vouchers, within the community resources Orange, Seminole, Osceola, Lake County ADAP, Miracle of Love, Aspire, etc
- RS/NMCM Case Manager, our work contributes to measures established by the HIV/AIDS Bureau (HAB) Measures and the Department of Health Human Services
- Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.
- Acted as a liaison between referring physicians and specialists, establishing trust and rapport through professionalism.
Patient Access Specialist - Insurance Benefits Investigation
AssistRX (Apellis - Syfovre)
Orlando, FL
10.2023 - 04.2024
- Benefits investigation involving the analysis and interpretation of insurance coverage, claims reviews, approvals, and denials
- Speaking directly with patients' medical insurance companies to perform benefits investigation and EOBs to qualify patients for eye care injections for an FDA approved treatment drug Syfovre (Pegcetacoplan) injection on those who have been diagnosed with Geographic Atrophy
- Verified medical insurance using Availity or provider online portal
- Quality-controlled calls always score 95% or higher
- Recapping the information verbatim to confirm the copays, deductibles, coinsurance, prior authorization, buy & bill, and specialty pharmacy
- Updating member's demographic information and enrolling for open enrollment
- Patient Access Specialists must adhere to program rules while providing high quality service that is both efficient and effective
- Provided exceptional customer service, addressing patient concerns promptly and professionally.
- Verified insurance coverage and obtained necessary authorizations to ensure timely billing and reimbursement.
Credit Associate/Fraud Dept/Accounts Receivable
White Cap (Insight Global-Contract)
Orlando, FL
07.2022 - 10.2023
- Responsible for the routine maintenance of accounts receivable calculations and records, including cash receipts, claims, and overdue invoices
- Performs all phases of credit applied on processing within established standards and knowledge of lien waivers
- Process industrial loan & line of credit applications for approvals
- Analyzes exceptions and reviews correspondence to appropriate departments for follow-ups on unresolved items
- Investigate business applications for fraudulent activities or inaccuracy
- Performs basic data entry and general research within department systems to update and maintain account information
- Verifies data entry of account information in multiple systems
- Uploaded completed applications to appropriate credit system.
- Delivered diverse departmental administrative support to personnel.
- Managed sensitive client information securely and confidentially, adhering to all applicable data protection regulations and company policies.
Education
Certified Nurse Assistant -
Daytona Beach Community College
Daytona Beach, FL04-2003
GED -
Gary Adult Education
Tampa, FL05-1997
Skills
- Analytical Thinking
- Detail-Oriented Focus
- Effective Team Leadership
- Client Engagement Strategies
- High Ethical Standards
- Healthcare Compliance Knowledge
- Efficient Appointment Coordination
- Insurance Eligibility Verification
- Health Information Privacy Compliance
- Authorization Management
- Referral Management
- Patient Authorization Management
- Appointment Coordination
- Effective Listening
- Case Coordination
- Patient Vital Sign Monitoring
- Patient History Documentation
- Clinical Office Operations
- Patient Admission Management
- Healthcare Terminology
Technical Experience
- Athena
- Provides Enterprise
- Salesforce
- TruCare
- CPR+
- EMR
- E-clinical
- Escribe prescriptions
- Patient Plus
Timeline
ACE-Escalations Team (Eylea) & PAS (Novo Obesity)
AssistRx
07.2025 - Current
Patient Access Consultant AR/Case Manager
Cencora (MMC Group Staffing Agency)
09.2024 - 02.2025
Referral Specialist/NMCM Case Manager
AHF AIDS Healthcare Foundation
04.2024 - 07.2024
Patient Access Specialist - Insurance Benefits Investigation
AssistRX (Apellis - Syfovre)
10.2023 - 04.2024
Credit Associate/Fraud Dept/Accounts Receivable
White Cap (Insight Global-Contract)
07.2022 - 10.2023
Certified Nurse Assistant -
Daytona Beach Community College
GED -
Gary Adult Education