Customer Service Data Entry

Shawna McKinney

**** ***** ******* ***** *********, GA 30236 916-***-**** ***************@*****.***

Professional Summary

Dedicated and polished Customer Service professional with over 10 years in call center and medical utilization experience, who is adept to handle various calls on a daily basis, multi-tasks and make quotas while consistently resolving client issues in a rapid manner.

Experience

COORDINATOR, SPECIALITY SCHEDULER KAISER PERMANENTE 10/2021-PRESENT

·Utilizes established guidelines to schedule appointments for specialty departments by telephone.

·Answer any questions members may have pertaining to primary or specialty appointments

·Confirm and provide data for member appointments

·Review external referral information with members and provide appropriate contact information.

·Utilize and navigate HNConnect to gain access to member data.

DENTAL ELIGIBILITY REP HUMANA 07/2023-10/2021

·Handled inbound calls from members inquiring about dental benefits

·Generated quarterly reports for Health Plans that showed percentage error

rates and overall quality scores for agents work.

·Advised agents and supervisors of areas of improvement and re-training

when it came to errors and patterns

·Resource for agents when needing assistance with questions or workload

QUALITY ASSURANCE AUDITOR RIVER CITY MEDICAL GROUP 10/2019- 06/24/2021

·Audited customer calls and authorization creation of over 20 agents daily

·Generated quarterly reports for Health Plans that showed percentage error

rates and overall quality scores for agents work.

·Advised agents and supervisors of areas of improvement and re-training

when it came to errors and patterns

·Resource for agents when needing assistance with questions or workload

·Quality Assurance

UTILIZATION MNGNTMNT COORDINATOR RIVER CITY MEDICAL GROUP 2/2018-10/2019

·Created Medi-cal and Medicare authorizations for providers and patients

·Quota based Data Entry of ICD- 10, HCPCS, service and procedure codes

·Approved and denied authorizations based on medi-cal guidelines

·Generated and faxed denial, modification, eligibility, delay, approval letters and notifications

·Ensured authorizations were completed within appropriate timeframes based on contractual guidelines

·Request clinical records if necessary for authorization completion

·Medical Credentialing

CLAIMS EXAMINER I HEALTH NET 9/2016-09/2017

·Processed 120 plus Veteran Affairs (VA) and TRICARE Claims daily

·Reviewed claims to determine payable

·Confirmed valid ICD -10, CPT and HCPCS codes used on claim

·Returned claims to providers if pertinent information missing

·Submitted request for re-issuance of checks if never received

HEALTHCARE ELIGIBILITY REP HEALTH NET 6/2014-9/2016

·Handled 100 plus inbound calls from Medi-Cal and Cal Medi -Connect recipients

·Explained difference between PPO’s, HMO’s and Fee for Service ( FFS )

·Submitted appeals and grievances on behalf of members and providers

·Confirmed enrollment and eligibility in state managed plans

·Checked claims status, reasons for denial of claim for providers

Education

SEASIDE HIGH SCHOOL, SEASIDE CA

·High School Diploma, 2002

HARTNELL COMMUNITY COLLEGE, SALINAS, CA

·Attended 08/2002-06/2004

SACRAMENTO COMMUNITY COLLEGE, SACRAMENTO, CA

·Attended 08/2004-06/2005

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