Shaaron Wheeler

Mansfield,TX *****

ad1bih@r.postjobfree.com

Summary

• Experience of working as Manager, Customer Service Professional and Quality control auditor for healthcare industry.

• Maintained and updated regional managed care clients relationship.

• Overseen and to ensured achievement of contractual deliverables and service levels.

• Advised Pharmacies and Providers of policy holder benefits.

• Processed Pharmacy claim rejections.

• Answer four-line office phones and handles and solves whatever situations arise with that call

• Catholic Charities Volunteer

• Immigration Services-youth counselor

Skills

• Insurance/Prior Authorization

• EMR

• Microsoft Office

• Heavy Data Entry; Typing Speed: 45+WPM

• Managed care

• Home Health/Assisted Living

• Patient Scheduling

• Customer service

• Medicare/Medicaid

• HIPPA

• Teams software

• Mortgage Post Closing

Education:

• High School - Central Commercial High New York,

Worcester State College- Major: Social Work

Professional Experience

PRN Various Remote jobs

i.e. Scheduling Visiting Nurse Appointments. CSR

KBS Home Health

April 2022-May 2022

CSR III Remote

• Provide excellent customer service to all employees, patients and clientele who enter our offices or call on the phone

• Answer four-line office phones and handles and solves whatever situations arise with that call

• Maintain patient charts in an organized fashion

• Makes and receives all calls relating to documents for patients from any social service agency

• Made sure all licenses were up to date

• Data entry of all client medication profiles

• Prepares, coordinates and schedules in-service appointments for various Company representatives

• Provided weekly Monday report to Administrator of previous week duties, plans and outcomes.

• Community Liaison with Texas Dept. of Aging and Disability and other state Medicare or Medicaid related agencies In Milord Hands

August 2021-March 2022

Admissions Clerk/CSR

• Developed Managed Care positioning and strategic execution in the Divisions.

• Processed incoming Commercial and Medicaid Prior Authorization request via phone and fax.

• Advised Pharmacies and Providers of policy holder benefits.

• Processed Pharmacy claim rejections.

• Keep accurate update of all discontinued meds and new medications

• Schedule appointments as requested by visiting physicians to specialist appointments

• Made sure the clients were transported there on time

• Maintained and updated regional managed care clients relationship.

• Overseen and to ensured achievement of contractual deliverables and service levels.

• Developed Managed Care positioning and strategic execution in the Divisions. CDC Vax Project

April 2021 - July 2021

• Customer Service Representative III

• The Customer Service Representative III will respond to inquiries resulting from COVID-19 vaccination scheduling questionnaires or communications.

• Agents will answer incoming calls from the public related to COVID-19 vaccination scheduling and ensure appointments are set up correctly.

• Responding to numerous phone inquiries

• Using standard technology: telephones, e-mail and web browsers IN-Contact & AWS

• Completing daily electronic call logs

• Adhering to privacy rules

• Connecting callers with leadership as needed for escalations

• Responding to telephone inquiries within set time parameters In Milord Hands

October 2018 - March 2021

PRN / manager

• Assisted the director in his absence with maintaining client medical charts

• Schedule appointments as requested by visiting physicians to specialist appointments

• Made sure the clients were transported there on time

• Data entry of all client medication profiles

• Maintained and updated regional managed care clients relationship.

• Overseen and to ensured achievement of contractual deliverables and service levels.

• Developed Managed Care positioning and strategic execution in the Divisions.

• Processed incoming Commercial and Medicaid Prior Authorization request via phone and fax.

• Advised Pharmacies and Providers of policy holder benefits.

• Processed Pharmacy claim rejections.

• Keep accurate update of all discontinued meds and new medications

• Maintained physical client charts

• Handled various phone calls inbound and outbound concerning client information with medical agencies and family members

• Composed letters and other written materials (policies, procedure changes for agency as instructed by management)

• Performed other clerical duties as assigned in a timely manner Prometric

June 2015 - October 2018

Test Center Administrator (TCA)

• Maintain and apply expert knowledge of test center policies, practices and procedures

• Greet examinees at the front desk, verify identification and guide them thru center policies

• Administer and proctor tests

• Register and prepare candidate scorecards

• Digitally scan and record candidate fingerprint identification

• Continuously monitor candidates as they complete exams

• Resolve or report candidate issues

• Secure all computer software in the test center at all times

• Perform IT duties when necessary to keep flow ( replace & install Dell Wyse 7020 computers)

• Report any occurrences outside company guidelines to corporate management

• Assist with Employee schedules for Payroll.

• Assume Role & some duties of Test Center Manager-Corporate Liaison i.e. In Milord Hands

June 2012 - May 2015

PRN / manager

• Assisted the director in his absence with maintaining client medical charts

• Schedule appointments as requested by visiting physicians to specialist appointments

• Made sure the clients were transported there on time

• Data entry of all client medication profiles

• Maintained and updated regional managed care clients relationship.

• Overseen and to ensured achievement of contractual deliverables and service levels.

• Developed Managed Care positioning and strategic execution in the Divisions.

• Processed incoming Commercial and Medicaid Prior Authorization request via phone and fax.

• Advised Pharmacies and Providers of policy holder benefits.

• Processed Pharmacy claim rejections.

• Keep accurate update of all discontinued meds and new medications

• Maintained physical client charts

• Handled various phone calls inbound and outbound concerning client information with medical agencies and family members

• Composed letters and other written materials (policies, procedure changes for agency as instructed by management)

• Performed other clerical duties as assigned in a timely manner KBS Home Health Agency, Inc.

September 2008 - May 2012

Office Manager

• Provide excellent customer service to all employees, patients and clientele who enter our offices or call on the phone

• Answer four-line office phones and handles and solves whatever situations arise with that call

• Maintain patient charts in an organized fashion

• Perform Quality control on all documents Oasis Assessments, Nurses notes, 485, 60 day summary, Face-To-Face, Physician Orders and works closely with compliance consultant making sure state regulations are followed kept all communication written and filed per client chart

• Reviewed and filed all Discharges documentation, broke down patient charts, tracking system for easy finding

• Community Liaison with Texas Dept. of Aging and Disability and other state Medicare or Medicaid related agencies

• Makes and receives all calls relating to documents for patients from any social service agency

• Made sure all licenses were up to date

• Payroll Timecard review and preparation for payment for all employees

• Paid bills and kept all receipts and correspondence for all clients

• Ordered all supplies and set up and provided in-service training for all clinical and office personnel, staff of 15

• Prepares, coordinates and schedules in-service appointments for various Company representatives

• Provided weekly Monday report to Administrator of previous week duties, plans and outcomes. Cuddle Me Home Care

August 2007 - September 2008

Quality Control Auditor

• Review all Oasis forms for accuracy

• Contacted various clinical personnel by phone setting up Quality Control Audit Meetings Prepared materials and charts to be reviewed

• Maintained accurate minutes and provided copies for each individual and State agency

• Called various departments for trailing documents and made sure they were received and filed properly

• Trained new Registered Nurses in proper documentation of the software program

• Created a teaching tool "the importance of including teaching" for the nurses to use when visiting their patients

• Maintained discharged client charts according to implemented filing system.

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