Customer Service Data Entry
Resume:
P a g e *
Shontay L. Cole
Adobes Casas, AZ *****
***********@*****.***
Medical professional experienced in:
Intake, Grievances & Appeals, Insurance & Benefits, Credential Verification, Authorizations, Billing & Coding, Claims, Training, Mentoring, Administrative & Clerical responsibilities, Enrollment, Scheduling, and Medical & Clinical Management.
Experienced and knowledgeable medical professional with seventeen years of experience with; Private insurance, Federal and Government insurances (FEP, Medicare
/Medicaid, AHCCCS, DOD-Tricare- medical and clinical management,) EVV (electronic visit verification,) EMRs, account management, pharmacy benefit managers (Express Scripts, CVS etc.…,) Grievances/complaints, benefits and administration, payroll, and full cycle billing. ICD10, HCPC- CPT coding and authorizations, claims processing and review, scheduling, credentialing verification, intake, professional training in various settings in conjunction with strong customer service etiquette in all capacities. Well versed in HIPAA and PHI requirements and standards with dispatch, intake, and routing experience. Seeking to continue a long-term career within the insurance and healthcare industry at a moderate level position.
Work Experience
CMA Program Coordinator/Care Coordinator III: Intake, Scheduling, Eligibility verification, Clerical & Administrative, Account management, Data entry & Management, Provider contact.
HealthNet Federal- Department of Defense -Tricare T5 Contract/Prescription Monitoring Program (REMOTE)
July 2023- Present
Works with senior care management team to support care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Serves as P a g e 2
a liaison alongside care managers and providers to ensure proper coordination of care for members utilizing data and provider management systems. Sr. Health Services Associate: Intake, Scheduling, Authorizations, Benefits & Provider verification, Training.
McKesson- Scottsdale AZ (REMOTE)
July 2022 - July 2023
As a Senior HSA, responsibilities include insurance verification, knowledge of insurance billing procedures. Data collection within the application of HIPAA practices and PHI procedures and processes. Strong emphasis on benefit verification for new cases. Inclusive to understanding and the application of insurance authorization procedures and medical/pharmacy benefit verification. Customer service-oriented position dealing with patients, professionals, facilities, and medical staff at a high engagement level with knowledgeable professionalism and punctuality.
DME Coordinator: Intake, Scheduling, Training, Dispatch, Billing. State Serv Medical - Mesa, AZ (REMOTE/HYBRID)
March 2020 - July 2022
As a DME Coordinator, responsibilities were inclusive of but not limited to; handling of, updating and interpreting EMR, intake, receiving/making large volume of calls both inbound and outbound. Extensive multitasking at a fast pace. Knowledge of billing practices; HCPC codes, ICD-10, application of HIPAA practices and PHI procedures and processes. Dispatching, routing, and processing/verification of new orders. All administrative and clerical tasks. Training of new hires and continual up training regarding patient sensitivity, product knowledge and health and safety regarding products and their medical usage and application. Loss prevention and cycle billing. Private pay and insurance authorization procedures and benefit verification. Benefit administration and fee for service knowledge. Customer service-oriented position dealing with hospice patients, facilities, medical staff, and family using tact, professionalism, and sensitivity.
Client Services Coordinator: Trainer, Scheduler, Claims, Administrative responsibilities, Case/Clinical Management
Accent Care - Phoenix, AZ (HYBRID)
August 2019 - March 2020
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As the primary support for daily EVV and payroll functions, responsibilities included knowledge for processes and communicating authorization and schedule changes to ensure coordination of service and client satisfaction. Job functions also entailed coordination of Care Partner teams to; ensure fill rate expectations are met, research and resolve payroll and billing questions under direction from the Client Service Manager. Liaison for Field Supervisors in communicating with payer Case Management teams and supporting recruiting and onboarding needs of teams. Responsible for scheduling, monitoring, and reporting all required client visits by field supervisors. Presentation of staff training related to program requirements for newly hired and current office employees. Performed other duties and special projects as assigned, such as clerical and administrative responsibilities coupled with verification of employee required certifications and credentials; compliance with applicable legal requirements, standards, policies, and procedures including, but not limited to the Compliance Program: Code of Conduct, OSHA safety, HIPAA, and Documentation Standards Intake Coordinator: Medical Billing and Coding, claims, Medical Management, Scheduling, Dispatching, Credentialing, (Pecos) Verification. Preferred Homecare - Phoenix, AZ (ON SITE)
June 2017 - July 2019
Primary responsibilities are the monitoring and processing of intakes for wound care supplies, ostomy, DME and urological supplies. Coupled with scheduling and full cycle billing for enteral and negative pressure wound therapy. Versed in medical billing practices; ICD10, CTP and HCPC coding, along with insurance verification and authorizations (procedure, medications.) Processing large volumes of outbound and inbound calls. Application of customer service with both outside referrals, patients and other medical facilities and professionals. Resolving inquires in accounts, queues, and new cases within time sensitive constraints in a fast-paced and multi-tasking environment.
Transfer Coordinator: Intake, Admissions, Scheduling HonorHealth Medical Centers - Scottsdale, AZ (ON SITE) July 2013 to June 2017
Liaison between patients within and outside the Honor Health network in conjunction with working directly with physicians and specialists to facilitate and expedite above mentioned transfers within and outside of the Honor Health network. Responsibilities also included front desk and admission(s) knowledge as a unit coordinator. Multi- functional with administrative, clerical and insurance authorization duties that include P a g e 4
but not limited to; daily audit and billing reports, bed placement and scheduling, admitting, benefits verification and transportation assistance. Unit Coordinator and dispatch experience.
Clerk I: Intake, Grievances & Appeals, Training, Authorizations, Benefit verification, claims processing/review.
Express Scripts Inc - Tempe, AZ (HYBRID)
February 2004 - June 2013
As a Clerk I and in conjunction with the duties of a Patient Care Technician, job functions included but were not limited to; resolving customer issues within required time limits and constraints regarding complaints and inquiries, re-evaluating electronic and manual claims, providing accurate and detailed information to members pertaining to their specific pharmacy benefits and plans, appeal(s) and grievance(s) policies and procedures, billing and scheduling, up training to tenured employees and providing training to new hires. Account(s) management according to HIPAA & PHI laws and regulations.
Education
ABSN/ Nursing Program
Grand Canyon University
March 24- present
Medical Coding & Billing
Ashworth University
November 2018 to 2020
Associates - AGEC
Gateway Community College - Phoenix, AZ
2014-2017
GED
Gateway Community College
2004
Basic Education
South Mountain High School
1995 to 1998
*Authorized to work in the US for any employer
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