Shameecka Angus

Phone: 347-***-**** E-Mail: ad3069@r.postjobfree.com

OBJECTIVE: Experienced Credentialing/ Enrollment Coordinator with quality verbal and written communication skills, seeking a position where leadership, organizational & time management skills as well as attention to detail will be required. Strong experience with prioritizing multiple projects and meeting deadlines. Experienced interacting with individuals at all organization levels. Solid team building & customer service skills along with excellent office etiquette & switchboard experience. Experienced handling confidential information with much discretion and diplomacy. EXPERIENCE

Palmetto GBA, Provider Enrollment Analyst, Remote- Jacksonville, FL 09/2021- Present

• Screens, validates and processes sensitive information submitted by Medicare providers in the JJ and JM jurisdictions to process web-based and paper applications

• Conducts research, resolves issues and responds to telephone & written inquiries from providers related to completing the Medicare application as well as status

• Identifies cases of suspected fraud as well as any sanctions against provider licenses and certifications

• Verifies provider information and credentials via government web-based databases

• Provides clear & concise file notations using the iFlow Tracking System as well as Provider Enrollment Chain Organization System (PECOS) system

• Completes audit/verification processes using the following:

System for Award Management (SAM)

Medicare Exclusion Database (MEDs)

Office of Inspector General (OIG)

State & CMS provided High Risk provider database

• Performs research & development tasks for additional information as needed to complete the enrollment application

• Interacts daily, verbally or in writing, with physicians, attorneys, billing agents, and third-party vendors in order to ensure timely & accurate processing of information

• Creates logging & tracking records in the Provider Enrollment Chain Organization System (PECOS) to enroll Medicare providers & updated enrollment information as necessary

• Establishes Electronic Funds Transfer (EFT) for provider Medicare payments, using the Medicare Part B Multi-Carrier Claims Processing System (MCS) system

• Acts as a customer service liaison to ensure that complex issues are resolved timely

• Ensures all national and state standards are met in a timely and accurate manner

• Utilizes effective written & verbal communication skills, strong organization skills

• Demonstrates problem-solving, decision-making skills, & team building skills in order to maintain excellent quality & production standards as well as a cohesive work environment The HCI Group, Inc., Trinity Health Team Lead, Remote- Jacksonville, FL 02/2020- 06/2020

• Supervised teams of 10-20 data abstractors for the Trinity Health System Primary Care Physician (PCP) data migration project

• Facilitated daily huddles/meetings with team members and shift supervisors

• Outlined daily objectives and review abstraction error trends and solutions

• Supervised the transfer of Electronic Medical Records (EMR) information from NextGen Healthcare Information Systems into Epic Hyperspace 2019

• Maintained HIPAA compliance as well as 100% accuracy and quality for every record processed

• Served as quality audit analyst for EMR records abstracted

• Ensured no less than 20% of records abstracted are audited for each data abstractor per shift

• Confirmed all information included in the abstraction data scope was captured accurately & completely

• Completed data audit Smartsheet for each quality audit processed; notated and reported all critical errors

• Reviewed all errors with each team member to ensure proper re-training of data abstraction scope

• Completed all data abstraction error corrections for each team member

• Tracked all critical errors for each team member via Smartsheet and Microsoft Excel for refresher training purposes

• Completed daily shift report for the management team outlining attendance, critical errors, technical issues, and any other factors which impacted the production standard for the day

• Participated in weekly refresher training courses to ensure current knowledge of all changes incorporated into the data abstraction scope for the client

R1 RCM, Inc., Authorization Specialist & Scheduler, Jacksonville, FL 07/2019- 11/2019

• Screened new patient referrals and authorizations to ensure all required fields of information were submitted correctly

• Verified patient insurance information as indicated on the referral via the following databases:

Availity Healthcare Clearinghouse

Emdeon Healthcare Clearinghouse

Humana Military

Florida Medicaid Managed Information System (FLMMIS)

various insurance payers Interactive Voice Response (IVR) via phone

• Recorded patient benefit information into the R1 Hub Technology system (Tool) as well as Trace (patient referral database)

deductible remaining

out-of-pocket maximum remaining

co-payment or co-insurance amounts

visit limitations

authorization/referral requirements

• Contacted patients for new patient evaluation and treatment (follow-up) scheduling & reviewed current benefit information also advised of any payments due at time of service

• Maintained contact with primary care providers as well as referring providers for authorization requests

• Requested authorizations/referrals for both evaluation & treatment scheduling

Availity Healthcare Clearinghouse

Facsimile to various insurance payers, including Medicare & Medicaid

• Responded/followed-up on denial and/or appeals requests as requested by therapist & patient

• Communicated authorization/referral information with therapist/provider via patient chart

advised provider of total number of pre-approved visits to avoid authorization related claim denials

• Demonstrated excellent customer service in scheduling

explained benefit information

provided directions to the facility

• Communicated with providers/therapists to clarify and/or answer any questions regarding requirements of various payer policies to ensure payment and compliance

R1 RCM, Inc., Patient Reg./Front Desk Associate, Jacksonville, FL 03/2018- 07/2019

• Performed registration and insurance verification, ensured collection of seven critical data elements necessary for proper patient identification and billing

• Identified and updated patient demographic information on ADT system as defined by departmental policy and procedures

• Interpreted physician orders for appropriate testing or admission criteria

• Coordinated patient admission needs and beds assignment to facilitate timely patient placement

• Identified non-participating insurances or out of networks plans

took necessary steps to inform patients and physicians regarding options, including but not limited to canceling an appointment

• Obtained insurance card copies or validated insurance information via electronic medical record (EMR/EHR), transfer information, or insurance eligibility tool

• Provided courteous and accurate patient and hospital information with destination directions & instructions for patients, families, visitors, and ancillary areas

• Prepared documents for imaging/scanning into electronic patient record

• Explained processes and forms to patients prior to securing signatures

ensured that all documents were properly signed and witnessed as required

• Assembled and disassembled patient charts or departmental documents according to department policy

• Copied and/or faxed documents to ancillary areas or physician offices

• Maintained inventory control of forms, paper, and office supplies needed in area

• Assisted with all possible account resolutions pertaining to patient balances First Coast Service Options, Provider Enrollment Analyst, Jacksonville, FL 07/2017- 03/2018

• Screened, validated and processed sensitive information submitted by Medicare providers

• Conducted research, resolved issues and responded to telephone & written inquiries from providers related to completing the Medicare application as well as status

• Identified cases of suspected fraud as well as any sanctions against provider licenses and certifications

• Verified provider information and credentials supplied by the applicant

• Made clear & concise file notations using Provider Enrollment Tracking System (PETS) as well as Provider Enrollment Chain Organization System (PECOS)

• Completed audit/verification processes using the following:

System for Award Management (SAM)

Medicare Exclusion Database (MEDs)

Office of Inspector General (OIG)

Florida Department of Health Medical Quality Assurance database (FLMQA)

State & CMS provided High Risk provider database

• Performed research & development tasks for additional information as needed to complete the enrollment application

• Interacted daily, verbally or in writing, with physicians, attorneys, billing agents, and third-party vendors in order to ensure timely & accurate processing of information

• Created logging & tracking records in the Provider Enrollment Chain Organization System (PECOS) to enroll Medicare providers & updated enrollment information as necessary

• Established Electronic Funds Transfer (EFT) for provider Medicare payments, using the Medicare Part B Multi-Carrier Claims Processing System (MCS) system

• Acted as a customer service liaison to ensure that complex issues were resolved timely

• Assured all national and state standards were met in a timely and accurate manner

• Utilized effective written & verbal communication skills, strong organization skills

• Demonstrated problem-solving, decision-making skills, & team building skills in order to maintain excellent quality & production standards as well as a cohesive work environment Aetna, Inc., Eligibility Consultant for Managed Staffing, Jacksonville, FL 03/2017- 06/2017

• Verified enrollment status, made changes to member/client records, and addressed a variety of enrollment questions or concerns

• Maintained enrollment databases and coordinated electronic transfer of eligibility data

• Processed accurate/timely eligibility data into Aetna, Inc. Foundation Systems to ensure production of National Account member ID cards, electronic listings and audit reports

• Corrected adjudication of member/provider claims

• Utilized Aetna’s Administration System (AAS) and Member Enrollment Application (MEA) to correctly enter eligibility transactions (enrollments, changes, terminations) via batch, online, or file upload facilities

• Ensured eligibility transactions successfully interfaced downstream systems based on an understanding of each system’s processing rules and interface limitations

• Reviewed enrollment forms, listings, or electronic file specifications to assess customer and vendor ability to adhere to Aetna, Inc. standards

• Resolved eligibility issues generated from the customers claim office

• Responded to customer/vendor requests for information, problem resolution, or online transactions

• Acted as a consultant influencing decisions regarding customer and vendor eligibility submission processes

• Actively participated in new business installation meetings with Aetna, Inc. sales/service representatives and customer/vendor benefit and programming staff

• Determined special programming needs as necessary

• Followed up on file testing to ensure transmission of electronic eligibility can occur

• Worked closely with other team members to meet financial/data requirements Florida Blue, Enrollment Coordinator for Brooksource Staffing, Jacksonville, FL 08/2016- 12/2016

• Reviewed and assessed small group new sale and renewal enrollment packages for completeness and accuracy

• Determined if compliance requirements with state & federal mandates and Florida Blue Small Group Underwriting Guidelines were met

• Processed all new sale and renewal groups (medical and ancillaries), SHOP groups benefit changes, eligibility changes, name changes, etc. in Siebel

• Prepared final rating for groups and communicate to the agent

• Recorded group details in Siebel and notated each defect and follow up activity in the Siebel EUR Notes section

• Performed follow up activities and communicated either by email and/or phone call with the following:

Agents

agent coordinators

area managers

wholesalers

FCL contacts

Small Group Renewal Unit (SGRU)

other internal areas in a timely manner

• Coordinated with internal areas EM& B, PRA, FCL, Underwriting, CPIM, etc. to resolve issues or validate compliance

• Managed daily inventory to ensure responses were received and appropriate actions were taken and completed within required timelines

• Prepared documentation for group setup for use by other internal areas Southeastern Grocers, Category Assistant for Kavaliro Staffing, Jacksonville, FL 08/2015- 07/2016

• Utilized the Sales Plan Management System (SPMS) to input & adjust proposed promotional/sale data, which included item codes, prices, projected movement data, & layout location information

• Validated, approved, rejected, or cancelled vendor contracts via the Deal Management System (DMS) against the promotional calendar allowance commitments

• Updated allowances in SPMS and coordinated updates with category buyer/manager as necessary

• Produced weekly SPMS reports to review projected financials for three weeks at a time

• Researched, resolved & responded to promotional inquiries at store level

• Utilized the H.U.B. & OMI systems to set up new items for direct store delivery (DSD) & warehouse storage

• Utilized the Citrix System (HQ) to maintain several types of promotional entries ready for store tag print, which included:

advertised

temporary price reductions (TPR)

Buy One Get One (BOGO)

Markdowns

Clearance

• Performed data integrity tasks such as maintaining new items & phasing out discontinued items from both warehouse & DSD systems

• Maintained price association codes (PAC) for similar like items by vendor sharing same unit costs & regular retails

• This position also provided clerical support to the Snacks & Candy Category Director & Manager & performed other job-related duties as assigned

First Coast Service Options, Provider Enrollment Analyst, Jacksonville, FL 11/2013- 08/2015

• Screened, validated and processed sensitive information submitted by Medicare providers

• Conducted research, resolved issues and responded to telephone & written inquiries from providers related to completing the Medicare application as well as status

• Identified cases of suspected fraud as well as any sanctions against provider licenses and certifications

• Verified provider information and credentials supplied by the applicant

• Made clear & concise file notations using Provider Enrollment Tracking System (PETS) as well as Provider Enrollment Chain Organization System (PECOS)

• Completed audit/verification processes using the following:

System for Award Tracking (SAM)

Medicare Exclusion Database (MEDs)

Office of Inspector General (OIG)

Florida Department of Health Medical Quality Assurance database (FLMQA)

State & CMS provided High Risk provider database

• Performed research & development tasks for additional information as needed to complete the enrollment application

• Interacted daily, verbally or in writing, with physicians, attorneys, billing agents, and third-party vendors in order to ensure timely & accurate processing of information

• Created logging & tracking records in the Provider Enrollment Chain Organization System (PECOS) to enroll Medicare providers & updated enrollment information as necessary

• Acted as a customer service liaison to ensure that complex issues were resolved timely

• Assured all national and state standards were met in a timely and accurate manner

• Utilized effective written & verbal communication skills, strong organization skills

• Demonstrated problem-solving, decision-making skills, & team building skills in order to maintain excellent quality & production standards as well as a cohesive work environment GAP Inc. (Banana Republic), Visual Specialist, Jacksonville, FL 07/2007- 06/2015

• Utilized the corporate concepts manual and styling guide to select items to dress the style icons (mannequins) for the following displays:

window displays

sales floor

top shelf displays

• Ensured the product was merchandised to standard for the company’s target market

• Participated in the marketing and merchandising functions of the store:

price signage

product replenishment

price markdowns

• Greeted all guests upon entrance in the store, & advised of current sales and promotions

• Offered and advised guests of the benefits and advantages of the Banana Republic/GAP Inc. brand credit card

• Achieved brand card champion status across all three major divisions, which increased sales volumes as well as revenue across all brands

• Assisted with any shopping needs, including contacting nearby stores for items unavailable in the store

• Participated in store (receiving) shipment processes which included

debagging

sorting

sales floor & back stock product placement

• Operated cash till as needed, for all sale and return transactions

task required working quickly and efficiently to process guest transactions in a timely manner

ensure guests have an exceptional Banana Republic/GAP Inc. shopping experience Philadelphia Department of Human Services, Administrative Coordinator Philadelphia, PA 08/2008- 11/2010

• Served as the primary contact for scheduling and co-facilitating the Reintegration Oversight Committee (ROC) meetings

• Recorded data for the Reintegration Initiative Program as well as managed various databases to track youth within the program

• Participated in updating the Performance Standards for Reintegration Services, which served as the paradigm from which the Reintegration Workers administered service and care

• Created and revised various forms for the Reintegration Initiative Program

• Recorded minutes for advisory board meetings

• Participated in all activities necessary to meet the needs and goals of the grant-funded program Convergys Corporation, Web Content Developer for Adecco Technical, Jacksonville, FL 07/2006- 07/2007

• Participated in the Human Resources implementation phase for the DuPont Corporation

• Performed quality assurance methods for all Business Requirements Narrative Documents

• Assisted business analysts with editing and quality assurance for several work streams, which included Client Relations, Employee Relations, and Labor Relations

• Designed custom templates for all policy information for the Knowledge Management System.

• Created methods and procedures to compliment service center agents with call handling and client database management

• Performed all duties necessary to ensure the success of the implementation phase of DuPont’s Human Resources department

Adecco Technical, Office/ Recruiting Assistant, Jacksonville, FL 05/2006- 07/2006

• Assisted the Senior Technical Recruiter with client search and applicant screenings for technical positions via internet, telephone, and applicant database

• Maintained the database for clients and applicants

• Performed reference & employment verification for new applicants and recorded the findings

• Organized and maintained payroll files for the local office

• Recruiting assistant position also entailed extensive administrative and clerical tasks EDUCATION

Webster University 12/2011 MA Management & Leadership Jacksonville University 05/2006 BA Music Business with a Marketing concentration SKILLS

Attachmate Xtra! X-Treme Mainframe Applications and Programs including, Medicare Part B Multi-Carrier Claims Processing System (MCS), Regular Business Membership System (RBMS), and Micro Focus Rumba 9.2 mainframe application; Provider Enrollment Chain Organization System (PECOS); the Provider Enrollment Tracking System

(PETS); iFlow Tracking System; the Oracle Imaging & Process Management System; WeQ Web Imaging System; Siebel Financial Services; Sales Force Automation; Cerner (One Care); NextGen Healthcare Information Systems, Epic Hyperspace 2019 patient EHR/EMR data entry system, Availity Healthcare Clearinghouse; Emdeon Healthcare Clearinghouse; Florida Medicaid Managed Information System (FLMMIS); Humana Military (Tricare benefits verification); Trace (electronic patient order tracker); Phreesia Patient Intake program. Experienced working with 2019 ICD 10 and CPT codes. Data entry 60 WPM, experienced working with Microsoft Office including Excel (created & maintained spreadsheets as well as utilized Excel to house database information), Outlook, Microsoft Teams, iWork 2020, Internet Explorer, Safari, Microsoft Edge, Lotus Notes, Voalte messaging, Adobe and medical terminology. Extensive administrative knowledge & experience in an office setting; as well as 20+ years of customer service experience. Experienced as a switchboard operator, as well as sales, promotions & marketing. Member of National Association of Medical Staff Services (NAMSS).

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