Customer Service Medical
Resume:
Shavon Williams
Cypress, TX 77433
ac1net@r.postjobfree.com
CAREER OBJECTIVE:
Outgoing, motivated team player eager to contribute dynamic customer service, administrative, supervisory, team building, and organizational skills towards supporting the objectives of an organization that rewards reliability, dedication, and solid work ethics with opportunities for professional growth.
PROFESSIONAL EXPERIENCE:
Aurora St. Luke's Medical Center- Milwaukee, WI
Medical Staff Coordinator, (02/2017- 07/2017)
Responsible for acting as a liaison between Medical Staff departments as well as performing task in accordance to physician privileging and Credentialing.
Oversee the collection of physician data to ensure timely and accuracy of credentialing applications for appointments, re-appointments.
Responsible for working closely with service chiefs and hospital leadership while organizing and presenting in meetings such as Credentials Committee, Medical Executive Committee, and Medical Staff Leadership Council meetings.
Responsible for adhering and enforcing to medical staff bylaws, and communicating the need for revisions and additions.
Responsible for recording Committee Meeting minutes.
Responsible for collaborating with other Medical staff departments to ensure production and goals are being met.
Oversee the collection of expirable documents such as licensure, DEA, and Malpractice Insurance required for physicians and allied health professionals.
Responsible for monitoring/proctoring documentation necessary for special or new privileges to physicians based on guideline criteria.
Responsible for adhering to all hospital guidelines such as the HIPPA designed to detect and prevent and unauthorized disclosure of PHI.
Ensured all physician/AHP data base is updated and current for all medical staff services credentialing systems.
DentaQuest - Grafton, WI
Recipient of the Spot on bonus Award 2015 & 2016
Lead Provider Enrollment & Credentialing Coordinator, (10/2015-02/2017) (Lead over updates, PDM claims, Provider enrollment services)
Responsible for the auditing of all fee schedules created or updated by the Provider Enrollment and Credentialing team.
Responsible for Tracking and reporting audit results to management.
Assist management with training sessions to ensure the department is meeting assignment turnaround times.
Responsible for coordinating internal and external client audits.
Responsible for accurate and on time reporting on a monthly and quarterly basis as well as monthly and quarterly staff meetings.
Responsible for SQL queries to compare and resolve data that is inconsistent or incorrect.
Assist management in the implementation of department process improvements.
Maintained network participation by providing provider trainings and keeping benefit information updated as well as maintain a superior level of accuracy when processing changes to provider data in the claims payment system.
Responsible for coordinating and completing special projects as needed.
Responsible for claims reports and claim adjudication.
Responsible for all formal training of new and existing employees as well as reviewing/approving timesheets, approving time off request, and assisting in the hiring process including interviewing candidates..
Responsible for working with clients on issues related to operational and network requirements.
Assisted Management with introducing automated processes to help determine the quality of team performance.
DentaQuest - Grafton, WI
Recipient of the Spot on bonus Award 2014
Vision Specialist UM focused / Remote worker (10/2013- 10/2015)
Responsible for managing UM reports, tracking UM data, creating and updating UM documentation as well as working with other departments to ensure a cohesive process.
Responsible for creating and implementing the electronic MPA process while monitoring trends and data on an ongoing basis.
Responsible for provider recruitment, contract follow up, provider verification checks, and building provider networks.
Responsible for meeting with clients to determine processes and implement state requirements for different markets as well as provider trainings once process has been implemented.
Responsible for all UM procedures and updating ORM’s, CRD’s, and NOA’s for client approval as well as prepared monthly and quarterly reports. Responsible for following up with provider termination letters, add change forms and provider welcome letters.
Responsible for all PDL/NOA correspondence for all vision markets.
Responsible for assisting with complaints and grievances process by assisting with pulling needed documentation and client follow up as well as pulling needed info for client audits.
Responsible for building provider networks as well as negotiating special deals in areas that lack needed provider specialties to maintain compliance.
Responsible for training, assigning duties, and Q&A for co-workers on a daily basis while working closely with clinical director to ensure all MPA’s are processed in a timely and accurate manner
Patient Care – Milwaukee, WI
Recipient of the Raving Fans Award 2012-2013
Consumerism/Transparency Specialist (09/2012 - 10/2013)
Assisted members over the phone and through emails with all issues related to their health care benefits as well as educating them on becoming better health care consumers.
Created cost comparison reports that reflect a members out of pocket expenses for an upcoming procedure.
Searched member’s network to find in network providers as well as compiled quality information on physicians.
Dealt with various policy and administrative issues, developed reports and charts for budgeting and expenditure tracking.
Assisted members with detailed coverage information regarding their medical, dental, and vision plans.
Responsible for the security and maintenance of members protected health information.
Brookdale Senior Living – West Allis, WI
Procurement Specialist (01/2011-08/2012)
Negotiated and implemented local, regional, and national agreements to support the savings and service goals of the procurement team.
Assisted Brookdale associates with general questions on preferred suppliers and programs.
Responsible for Monthly reporting and analysis.*Created Purchase orders and Requisitions for all communities within Brookdale.
Responsible for Facilitating communication with Procurement Team, Accounts Payable, HR and other teams as necessary for consistency in research, quality assurance, and performance metrics and pricing.
Provided Support communication and training to associates of preferred programs and processes.
ABB INC – Waukesha, WI
Recipient of the WOW Award 2009
Warranty Administrator (03/2009 – 01/2011)
Responsible for processing invoices and issuing credit memos to consumers.
Responsible for entering and returning orders using SAP system.
Responsible for expediting orders on a daily basis with the shipping department to produce shipping labels and package product using UPS, FedEx and DHL methods. Responded to 50 plus calls a day in an inbound/ outbound call center.
Responsible for updating warranty procedures and providing updated versions to consumers.
Assisted customers with annual stock return and pricing for unused product.
Briggs & Stratton – Milwaukee, WI
Technical Customer Service Representative- Engine Division (04/2008 – 03/2009)
Provides troubleshooting techniques to resolve customer concerns and complaints.
Responsible for updating customer information and taking part orders.
Provides internet correspondence through emails.
Handled Retail business customer orders and technical questions.
Universal Mortgage Company – Mequon, WI
Lead Collections Representative (02/2005-12/ 2007)
Responsible for processing numerous claims per day.
Responded to 100 plus calls a day in an inbound/ outbound call center.
Made arrangements on accounts to prevent foreclosure.
Recommended accounts for foreclosure and to attorneys.
Collected payments on accounts and step up postdated payments.
Provided excellent verbal communications and warmth to customers.
Updated customer information as well as customer files.
Set up billing on numerous customer accounts.
OSI Outsourcing – Brookfield, WI
Call Center Representative (01/2001 – 01/2005)
Worked in a high volume inbound/outbound call center.
Maintained customer accounts, while providing problem solving solutions to customer concerns.
Responsible for setting up payment plans for customers.
Responsible for connecting and disconnecting electric service.
Responded to 100 inbound calls per day.
Education:
Penn Foster College
Medical Billing and Coding, June 2002
Additional Skills:
Excellent ability to adapt to difficult situations.
Ability to prioritize daily task while staying focused with constant interruptions.
The ability to stay productive with limited supervision.
Ability to meet tight deadlines.
Intermediate working Knowledge of Word, SAP, Excel, PowerPoint, SQL reports, and Outlook.
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