Customer Service Case Management

SHONTELL MURPHY

Jonesboro, GA ***** **********@*****.*** 470-***-****

PROFESSIONAL STATEMENT

Navy Veteran and community driven professional with over 20 years experience in case management,

provider relations, public relations, customer service, healthcare, data analytics, technical systems

deployment, SOW’s, MSA’s, contract negotiation, procurement, and project management. The ability to

effectively manage organizational change and build relationships with an emphasis on problem resolution and

goal accomplishment.

SKILLS

Military Disability Compensation Claims Coaching Case Management Contract Negotiation Provider

Relations Public Relations Customer Service HEDIS Data Analysis Healthcare Contract Management

Technology Systems Deployment Technical Project Coordination Financial Analysis Customer Service

Residential Loan Closing Notary Data Entry

EDUCATION

Central Christian College, McPherson, KS 2014

Bachelors Business Administration/Healthcare Management

University of Phoenix 2007

Associates in Business

SOFTWARE/SYSTEMS

Microsoft Office Word, Excel, Access, PowerPoint, OneNote, Outlook, MS Teams, Structured Query

Language (SQL), Network Data Base (NDB) IMPACT (Salesforce), Emptoris Contract Lifecycle

Management (CLM) Data Loading Instructions (DLI), Physician Contracting (PHYCON), SharePoint, My

Practice Profile, Vendor Solutions, Service Now. Workday, ECS, ECRM Electronic Customer Relationship

Management) Swoop Dispatch Management

EXPERIENCE

Veterans Advocate, Inc. Remote 12/2020- Present

Veterans Claims Agent

Hours per week 40

Advise and counsel veterans and their dependents about disability compensation benefits, and help them

understand why a claim was denied

File disability compensation claims for service connected disabilities, and disability increase requests, in

addition to assistance with VA home loans, and education

Provide referrals to veterans and their dependents to other agencies for assistance

Customer service advocate for veterans in need of services

Maintain client files while abiding by HIPPA regulations

Communicate with the VA on behalf of veterans

Answer inquiries and questions about laws and regulations concerning disability compensation

Collect statistics and reports about veterans benefit entitlements

Supervise, train and assign tasks to other Claims Agents

UnitedHealth Group (UHG) Remote 05/2019 – 12/2020

Network Contract Manager/Provider Relations

Hours per week 40

Collaborate with Network Account Managers, Provider Relations Advocates, and teams across the

UnitedHealthcare Network to safeguard a smooth transition into Veterans Affairs Community Care

Network (VACCN)

Extensive data research to confirm contract/amendment loads

Scan and upload docs to proper drive location as needed

Build amendments/contracts in Emptoris (IBM) and CLM (Contract Lifecycle Management) for

healthcare providers

Audit accuracy of provider load and data

Company Culture Ambassador

Provider Education for amendments, contracts, and data

Serve as conduit to submit contracts coming into market, which includes facility/ancillary into Vendor

Solutions Application

Respond to general internal questions regarding Veterans Affairs Network

Handle provider calls routed from customer care including routing, logging, and ensuring follow-up

using the OnBase tool

Bilateral amendment chase involving following up with providers relevant to the submission of

amendments

Process and close out Service Now cases by assisting community providers with but not limited to

demographic update instructions and creating VACCN contracts in Emptoris and CLM for

participation.

UnitedHealth Group (UHG) Maitland, FL 03/2017 – 05/2019

Provider Depiction Analyst/Roster Manager

Hours per week 40

Collaborated with Roster Operations Team, Network Account Managers, Provider Relations

Advocates, and teams across the United Health Network to guarantee delegated providers/groups

roster submission

Collaborated with delegate contacts to obtain Quarterly Attestations and Annual Rosters to retain the

accuracy of UHG provider directory

Utilized internal systems to submit provider demographic changes, certify provider portal access,

verify provider eligibility, view contract information and credentialing status

Reviewed status of the monthly provider updates submitted by delegated provider groups

Reviewed cases associated with the monthly submissions of provider rosters, updates, and provider

termination requests

Collaborated with delegated provider groups to ensure timely submission of monthly provider

additions/terminations/changes

Investigated provider data loading issues to resolution

Preserved high quality data submissions for provider groups/territories to Large Roster Cleanse (LRC)

Reviewed provider rosters for accuracy of required CMS data elements

Improved and sustained relationships with providers through resolving roster management issues

Produced weekly reports of provider demographic data

Provided education to healthcare providers and representatives to manage access for the UHG provider

portal

Communicated via phone/email to aid with navigation through various UHG systems, resources, and

tools to make sure providers kept CMS compliance

UnitedHealth Group (UHG) Maitland, FL 01/2017 – 03/2017

Project Coordinator HEDIS

Hours per week 40

Collected clinical information including demographic and medical records from Primary Care

Physicians (PCP), specialists and laboratories for HEDIS

Conducted initial analysis of records to determine compliance with HEDIS and NCQA requirements

Manipulated documents to confirm accuracy and maintenance of medical records within HEDIS

database tool

Conducted claims research, upheld accuracy of provider demographic locations, and verified member

history

Verified and confirmed provider demographics and medical record requests

Collaborated with member education and other multi-disciplinary teams to support Medicaid member

education department projects and compliance

Conserved HIPAA standards to include confidentiality of Protected Health Information (PHI)

Customer Service and documentation review, data entry

NextGen Healthcare Horsham, PA 12/2013 – 01/2017

Technical Deployment Coordinator (IT Project Coordinator)

Hours per week 40

Gathered business requirements for projects to confirm client was properly prepared for technology

upgrades and data conversions

Provided final approval for conversion or updates to deployment team.

Assigned conversions, Gap Analysis requests and KBM upgrades to deployment/conversion team.

Collaborated with other internal departments such as Support, Implementation & Training, Project

Managers, Account Relations, Development, and other coordinators to ensure client’s update readiness

Prepared clients for the testing phase of the Systems Development Life Cycle (SDLC)

Downloaded files from SharePoint site as needed

Verified required client education/training completion for new workflow prior to conversion

Responded to questions regarding workflow for KBM upgrade process, Meaningful Use (MU) and

ICD-10 requirements

Verified client acknowledgement and comprehension of Software Release Notes

Provided navigation support and assistance to clients

Communicated with clients about newly available NextGen EHR/KBM hotfix versions and BETA

releases

Submitted and maintained work orders for KBM improvements, UD’s, and Meaningful Use template

requests

Followed all applicable government regulations related to project compliance and HIPPA

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