Shakeyla Hayes
Raleigh
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
4
4
years of professional experience
Work History
Medicare Markets
BCBSMA
Hingham
09.2024 - Current
- Developed strong relationships with new and existing customers through proactive outreach via telephone conversations, emails and live chat.
- Scheduled and confirmed appointments.
- Ensured compliance with applicable regulations such as HIPAA Privacy Standards and CMS guidelines.
- Processed prior authorization requests for medications according to plan guidelines.
- Collaborated with other departments to ensure timely resolution of claims payment issues.
- Reviewed and processed prescription benefit requests from medical providers, pharmacies and members.
- Followed up on pending tasks until completion.
- Reviewed, corrected or deleted data, verifying customer and account information.
- Entered data into electronic systems with high accuracy and attention to detail.
- Maintained accurate records of patient information using EMR systems.
- Provided support in testing and validating AI model outputs.
- Attended seminars, workshops, webinars. to stay abreast of new developments in the industry.
- Assisted clients with claims processing and appeals when necessary.
- Provided Medicare customers with guidance and assistance in selecting the most appropriate insurance plans.
- Assisted clients in understanding Medicare plan options and benefits.
Dispatcher (Overnight)
Global Medical Response
Hingham
03.2024 - 09.2024
- Coordinated non emergency response calls and dispatched appropriate medical teams efficiently.
- Monitored multiple communication channels to ensure timely information flow.
- Utilized computer-aided dispatch systems to log and track service requests accurately.
- Maintained communication with drivers throughout the course of each trip to ensure they were on schedule and that no unexpected issues arose.
- Dispatched drivers to pick up patients in a timely manner while ensuring their safety and comfort.
- Responded quickly to non emergency situations involving medical transports requiring immediate attention.
- Answered incoming calls from patients, physicians and other medical personnel to coordinate medical transportation services.
Reimbursement Specialist
Aston Carter
03.2022 - 03.2024
- Communicated with insurance companies to resolve discrepancies in payments.
- Maintained detailed records of claims submissions and follow-ups in systems.
- Assisted patients in understanding their coverage options and claim status inquiries.
- Coordinated with healthcare providers to gather necessary documentation for claims.
- Verified technical reimbursement questions for providers, billing, and coding staff.
- Maintained a database of all reimbursements, payments, and other transactions.
- Analyzed patient data to ensure accuracy of reimbursement information.
- Verified that all necessary documents were included in each request before submitting it for payment.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Maintained records of all HIPAA violations and reported them as required by law.
Education
Southern Vance High School
NCSome College (No Degree) - Health Administration
Colorado Technical University
Colorado Springs, COSkills
- Claims processing
- Medicare compliance
- Prescription benefit analysis
- Data entry accuracy
- Remote office availability
- System monitoring
- EMR systems proficiency
- Prescription processing
- Healthcare reimbursement
- Appointment scheduling
- Artificial intelligence proficiency
- Benefits verification
- HIPAA compliance
- CMS guidelines adherence
- Medical terminology
Timeline
Medicare Markets
BCBSMA
09.2024 - Current
Dispatcher (Overnight)
Global Medical Response
03.2024 - 09.2024
Reimbursement Specialist
Aston Carter
03.2022 - 03.2024
Southern Vance High School
Some College (No Degree) - Health Administration
Colorado Technical University