Shakita Dawkins

Redford, MI *****

ad1jfh@r.postjobfree.com

+1-313-***-****

To increase client satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated organization staffed by knowledgeable, customer- focused professionals supported by exemplary technologies and processes. Willing to relocate: Anywhere

Authorized to work in the US for any employer

Work Experience

Care Coordinator

Centene - Detroit, MI

February 2021 to Present

• Completes an assessment/reassessment of overall member status evaluating members abilities and needs for services, at least annually.

• Reviews assessments and consult with care team members to participate in the development of the Person-Centered Plan of Service.

• Regularly shares information with guardians/family/ AFC staff regarding member care as appropriate

• Reviews member progress as indicated in the Person-Centered Plan and makes recommendations to other treatment team members as appropriate.

• Fosters members ability to function independently.

• Develops and maintains networking and referral contacts with other community agencies, social, economic, medical and mental health services.

• Link and coordinate members with identified resources to obtain needed entitlements and services.

• Monitors member progress toward treatment goals

• Follows through with assigned tasks

CASE DOCUMENTATION: involves recording comprehensive,accurate,timely records and statistical information detailing pertinent activities and service

• Completes Case Management Assessments in a timely manner.

• Completes Progress Notes in a timely manner

• Completes statistical data in a timely manner.

• Completes data detailing pertinent clinical information in a timely manner PBM Specialist

MedImpact - Novi, MI

October 2019 to March 2021

•Meet required turnaround times for processing incoming faxes and forwarding on to the appropriate Specialty Pharmacy Fulfillment Pharmacy (SPFP).

•Utilize the Specialty Hub application to informativeness to specialty pharmacies addition to the referral form, in order to expedite the fulfillment process for MID client members.

•Utilize multiple company database programs to research and resolve complex issues relating to benefit information, formulary compliance, eligibility verification, prior authorization, and other PBM processes.

•Provide information to MID Client/Members and Physicians about benefit plan restrictions, member eligibility, prior authorization requirements, and other PBM functions as specified by health plan sponsors.

•Follow up with callers(client members as well as physician provider offices)as appropriate to ensure customer satisfaction and timely response to requests. Diffuse irate or emotionally upset customers by appropriately listening to issues, calming the customer, and providing positive solutions to resolve concerns.

•Communicate both verbally and via email to the Specialty Pharmacy Fulfillment Pharmacies in order to provide a positive experience with the MID client members with regard to filling their specialty medication needs.

Medical Biller

Mednax - Lilburn, GA

May 2017 to August 2019

• Responsible for providing account registration, obtaining patient MRN, billing and administrative support to the physician(s).

• Performed HEDIS scheduling and over reminder calls to patients.

• Complete the registration (Daily Census Report) and billing of all accounts in the OBR system.

• Monitors and tracks appropriate Billing Report(s) to ensure encounters and activities are appropriately captured.

• Gathering and verifying current demographic information by speaking with the parents or hospital.

•Obtain and update new born infant names on all registered accounts within a timely manner.

• Obtain correct Insurance/Medicaid information from parents.

• Contacting insurance companies to verify insurance data on accounts.

• Utilize Payer Search program to obtain correct insurance code information

• Supply and obtain authorization numbers as requested by the insurance companies.

• Reviews medical records to identify opportunities for improvement as it relates to charge capture, reconciliation and missed diagnosis or CPT codes and provides timely feedback to physicians and providers.

Member Service Representative

Aetna - Detroit, MI

November 2015 to April 2017

• Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors Medicare/Medicaid.

• HEDIS tracking Pulling records, Contacting facilities for retrieval of records and Filing documents.

• Obtain Prior Authorization status, research denials assist with Appeals process.

• Explains member's rights and responsibilities in accordance with contract.

• Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals

• Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.

• Managed Member Service incoming email/web portal box

• Processed Member Services return mail/documents

• Trained New Hires using PowerPoint and Visio for presentations

• Daily use of Excel entering data into spreadsheet and v lookups Education

Associate in Science (AS) in Nursing

Wayne County Community College District - Detroit, MI September 2022 to Present

H.S. Diploma

Advanced Technology Academy - Dearborn, MI

2006 to 2008

Skills

• Microsoft Word, Excel,SharePoint, One Note, Outlook, Teams, Zoom (5 years)

• Medical Billing

• CMS guidelines, Insurance/Benefit Verification (CHAMPS, CMS and Web Dennis,TruCare), Knowledge of HIPPA regulations and Medical Terminology, HEDIS, Pharmacy Rx Claims (6 years)

• Insurance Verification

• Medical Records

• Medicare

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