Service Representative Data Entry

Shamonica Henley

(***) ***- ****

Email: ***********@*****.***

Qualifications

As an experience clinical administrative healthcare coordinator with 16 years’ experience in healthcare with a variety of experience from triage assessments, clinical referrals, Prior authorizations for pharmacy and healthcare coverage. Establish clinical operations to aim to evaluate the data analysis method to assist in obtaining quality measurements to help ensure and provide services for administering electronic clinical quality measures for improvements by patient and family engagements and implementing internal improvement programs to create Medicare advantage programs for quality members to help monitor preventative health plan measures. In aiding in healthcare for 16 years I have help develop a view of quality measures with management to service throughout the community help performance with healthcare. The ability to improvement clinical operations and performance in leadership, evidence-based decision making process approach is the central support in supporting physicians and practice staff engagements with the align in performance value measures. Identify gaps and assist in providing community resources to help each member establish PCP collaboration to access member’s medical records to support and measure quality and performance to improvement customer service and accuracy measures to collect data through effective utilization management of records for health plans and provider services. Cross functional operations to help delivery specifics in healthcare. Direct source for managed healthcare plans for providers, vendors and contractors case managers, social workers.

Work Experience

Customer Service Representative (Home and Business Loan Operations) / Small Business Administration (Contract) October 2021- Currently

Duties: Customer service financial support Processing documents for disaster survivors and victims of disaster relief. Providing Home loan and Business loan operations. Loan Assessments for qualifications upon applying for federal loan entry of various loans programs financial support operations with data manipulation and risk management analysis on government loan programs. Assist with Small Business Administrative duties with EDIL disaster relief and loans and customer support. Inform clients on account information to help assist with loan borrowing and options to help provide service in the community of disaster as relief options of support. Express with 504 (7) government loan guaranteed loans. Approval of closed documents review loan packages to help set up commensurate lending practices for through booking and funding government programs contract management and loan equality for various closing documents.

Customer Service Representative/American Family Insurance (Remote) November 2021 –Present Day (Contract)

Duties: Customer Service support IVR System, Insurance Payment Processing, help desk support insurance verification Inbound and outbound calls, Quality Assurance metrics and key performance measures monitors calls assist in billing support. Cancel / block insurance status policies and declaration over views. Dispatching to different departments roadside assistance, rental policies claim process, litigation and estimation reports for property damages, data entry, assisting in life insurance loan repayments, policy updates and contracts, assist with electronic Transfers, ACH debits from accounts. Create and schedule insurance payments. Commercial lines/ farm billing policies. Follow up and assist customers with insurance billing inquires, my account, insurance cancellations, declarations, Payment modifications, Review AFT transactions. Assist in scheduled overview of current policies and savings. Provide additional support to extended Third Party companies for property Insurance and Claims. Offer promotions and new provided services through American Family Insurance. Conduct training and job aids to support current customer service roles, provide sales and service operations for new and existing customers.

Clinical Laboratory Technician/ LabCorp Corporations of America January 2016 to May 2022

Duties: Provide healthcare service to clients and patient care in IOP Laboratory clinical responsibilities consisting up to performing collections by venipuncture, med adherence screenings for lab testing as well as a utilization of apheresis equipment. Establish proper identification of all donors, ensure accountability of specimens by proper and complete labeling with internal society of blood transfusion ISBT unit. Provide phlebotomy training for new personnel. Proper handling of transporting specimens and critical systematic information. Assist all healthcare team members in new and past accounts, collection of private insurance and explaining policies and reviews for effective cost to help with lab consumer needs. Provide training and support throughout the region with sensitive information. Charge card control. patient financial records for past record of account bills, NOBD balances reviews weekly card reports and cash transactions, vouchers of centralized and specialty practices that are kept disclosed for financial review on client accounts.

Practice Operations Manager / Dr. John A DE Clue D.O July 2007 to January 2016

Duties: As a Practice Manager for administrative and clinical operations consisting Provider services and patient care based in practices and specific strategies to improve medication adherence for Medicare services and star ratings. In addition to collaborate and assist with audits purposes and training. Locate and document medical screenings to review documentation for efficient and profitable operations. Assist in provider incentive programs to help the evaluation of clinical data to increase programs within CMS guidelines. Conduct training for medical staff also provide contract negotiation for other medical and satellite clinics. Conduct review of medical records and tracking systems with EMR, assisting with managed care and Pharmacy benefit coordination with practice performance operations in health plans to help Provide ongoing strategic recommendations for coaching and implementations as a result of resolution to help with provider education and training. Provide preventative health and star measure programs to ensure the knowledge of clinical standards of care. Educate providers on reimbursement policies collects medical charts for review provide multiple plat forms to provide medical practice administration policies and recovery payment options for practice. Provide quality measures on monitoring practice performance in addition to aiding in reimbursements for ICD -10 Billing and CPT codes. Responsible for Profit and loss management provides training on Health information systems to Provide service with HEDIS and FACETS for practice operations to help with utilization management to submit claims properly review billing for Medicare and Medicaid services provide. Review and check all claims for payer contracts. Follow up with metrics for score cards.

Billing & Contract Operation Specialist / New Horizons Community Service Board October 2005 to January 2010

Duties: Using multi data base systems for contract provider information in accordance with departmental policies with delegated providers to help with cross functional support to related contract services and implemented data with complex issues in quality improvement measures. Establish investigations on compliance implementation of corrective actions on internal audits, assist in recruitment of placing outbound calls preparing and tracking projects to help obtain and create new Provider and program packets. Evaluate and analyze impact of new revised changes to develop operations and implements for internal operations. Track compliance activities with operational matters special need operations, Medicare and Medicaid programs to ensure accurate on contract entities on governing contracts of provider payments of commission to external contractor’s producers, are accurately processed changes to information in the commission systems maintained organized records, research and calculations of payouts and reconciling contractor sub payments. Identify new ways to improve payee providers and enhancement of more contractual opportunities. Monitor change to laws and regulations to ensure compliance with state and federal laws, regulation and mandates establish and provide standard policies, procedures and best practice efforts with NHCSB to promote compliance with applicable laws contractual obligations. Conduct state specific legal research and monitor changes to requirements to mitigate risk and achieve compliance operations. Provide support for the CFO operations with data regulatory filings with coordination and development reports, projects assessment tools to verify compliance in community-based departments. Develop compliance communications and drive problem solutions for the best interest in business and billing operations with skills in Medicaid, Medicare reimbursement resources for claims and federal contractual and state rules. Knowledge of employment administrating training programs to help regional program lead operational programs. prepares and conduct workforce staffing and liaison with federal and state funded programs. Research and complies and analyze information and data to use in program administration recommendations identifies collective training with officials and other stakeholders internally and external workforce guidance and policies on individuals. Access to grant day to day on the Job training with different community agencies. Top quality service to clients and service members. Surveys data collection on training for mangers and departmental leaders. Conducting studies and findings in employee data and relationships with departmental rules regulations with chain of command in providing employee and manger relationships, attitude client fee back when assessing employer reviews. Provide and manage rules and regulations for house and ethical rules to provide further investigations on alleged miss conduct of members, officials and any violation of law and rules to the organization. Ensure compliance with research and protocol in equal employment opportunity programs that community outreach partners conducted with contracts with clients internal and external. Excellent analytic framework with deliberations framework and guidelines to deliberate final decisions adhering to staff and clients. Working with a wide range of community agencies for providing billing services for clients and administrative and clerical duties. Assisting accountants in maintaining 100% accuracy in Medicare and Medicaid billing. Proper evaluation in processing invoices for payment and providing a course of action with financial assistance on program accounts, daily trips, sub-contractor accounts for billing and tax preparations. Bookkeeping and Fiscal year budgets and audits with the Department of Human Health Services. Insurance processing. Monthly meetings with Chief Financial Officer of New Horizons CBS in keeping billing and budgets with the state of Georgia and community action plan.

BCBS / Utilization Specialist May 2003 to October 2005

Duties: Demonstrating internal claims and payments policies and procedures verifying daily provider contract operations to provide service for members to help oversee performance end to end provider claim enquires from internal teams to help with negotiation of fee and changes to network providers developments of claims, appeals and credentialing complaints of medical policies from regulatory benefits to help with the implementation of programs and quality reports to help with provider satisfaction and to help with internal improvements of provider, member and company performance. Verify benefits and eligibility information Responsible for coordinating the care of cases to help support care and plan goals by conducting assessments for pre certifications and Prior authorizations review. Claims creation and scrubbing for incoming request from providers utilizing scripts basic complex. Provide customer service on post service claim work determines the contract benefit and eligibility. provide authorization for inpatient admissions, outpatient pre certifications, PA, and post service request responsible for proper identifications of data entry into the utilization management systems in accordance with certificate plan. Conducts clinical screening process in addition to authorize initial set of sessions to providers. Check benefits for facility-based treatments, DME requiring to clinical review to a nurse reviewer and handles specialty care. Provide liaison between medical management and internal departments.

CVS Retail Pharmacy Technician / Pharmacy Service Coordinator October 2002 May 2003

Duties: Quality measures for Customer Service in Retail pharmacy setting, data entry processing prescriptions receive electronic and hand written prescriptions. Process prescriptions accuracy verifying insurances and prior authorizations for prescriptions. Enter prescriptions into pharmacy data base collect payments and process insurance for prescriptions complete financial transactions of controlled and over the counter prescriptions. Assist pharmacist in PCQ calls automatic refills, checking for out dated prescriptions, pulling recalls from store and pharmacy shelves. compounding various / creams and ointments as well as liquid oral medications accuracy of dispensing proper medications and dosage when filling prescriptions. Carefully reading sig codes to verify proper identification for customers as well as properly labeling and maintaining customer s profile for adverse and interactions with certain medications. Set up of Automated dispensing systems community pharmacy.

Education

Shaw High School

Columbus State University Columbus Georgia

Bachelor of science Business Administration 2020 GPA 4.0 (Currently Attending)

Columbus Technical College (General Studies / Business Law)

Virginia Technical College Pharmacy Technician Program (CPHT)

Certifications Taxation (Counting Education) Compliance / HIPPA State and Federal Regulations

PMP Certification

Compliance / Ethics Committee NHCSB

Volunteering Services/ Non-Profit Organization

United We Serve

Habitat for Humanity/ Homeless Network Center Columbus Georgia

Damascus Women Shelter

St. Francis Hospital

Columbus Regional /Pediatric Oncology / Children’s Miracle Network

Non-Profit Organization 501 c (3) F.L.A.W.S. & ALL Co- Founder

This organization is community based to help local kids with different backgrounds

Ethnicity origin all walks of life to help support our girls and young teens throughout the community Mentoring program.

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