Shatiera Gainyard
Greensboro
Summary
- As a healthcare professional I champion patient-first service, ensuring clients access vital treatments without unnecessary barriers. With a specialization in Health Services Administration Management from American InterContinental University, my role intertwines healthcare knowledge with account management acumen, directly impacting patient care by navigating insurance intricacies and advocating for timely reimbursement. Concurrently, as CEO of Sunbelle Boutique, I embody entrepreneurial spirit, steering a fashion-forward brand that promises confidence through style. My leadership not only inspires our team to deliver exceptional customer experiences but also reflects a dedication to quality and innovation in every facet of our operations.
- Excellent written and verbal communication skills with individuals at all levels, both one-on-one and in groups.
- Well-developed problem-solving skills to facilitate problem identification, generation of alternative solutions and adaptation to changing situations.
- Critical thinking and active listening skills necessary to interpret, analyze, and apply information.
- Good time management, adopting a flexible approach to work.
- Experience with Microsoft Office (MS Excel, MS Word, MS PowerPoint). Authorized to work in the US for any employer
Overview
11
11
years of professional experience
1
1
Certification
Work History
Reimbursement Case Manager
Aston Carter
10.2023 - 01.2025
- Having a "patient first" mentality while handling complex patient and provider interactions(inbound calls, BDs, etc...)
- Verifying insurance coverage, billing, reimbursement processes, and general access for Orgovyx
- Completing assigned daily tasks within KPI (BI, BD, Triage)
- Provide unparalleled customer service while serving as a brand advocate, and understands the importance of achieving quality outcomes
- Maintaining team morale by consistently demonstrating positive attitudes
Medical PreCertification Specialist
Blue Cross Blue Shield
11.2022 - 10.2023
- Answer incoming calls from providers and patients in regards to prior plan approval authorizations
- Confirming prior plan approval using available tools, resources and BCBS public website
- Processing Medical and Behavioral Health authorizations
- Provide informational update and Research clinical information pertaining to member authorization status
- Transferring Provider and patients to dedicated team lines for assistance in complex issues
Part-time | Service Ambassador
Guilford Health Care Center
02.2022 - 06.2022
- Serve visitors by greeting, welcoming, directing and announcing them appropriately
- Answer, screen and forward any incoming phone calls while providing basic information when needed
- Receive and sort daily mail/deliveries/couriers
- Maintain security by following procedures and controlling access (monitor logbook, issue visitor badges)
- Update appointment calendars and schedule meetings/appointments
- Perform other clerical receptionist duties such as filing, photocopying, collating, faxing etc
Enrollment Analyst
Change Healthcare
11.2021 - 06.2022
- Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement
- Receives denied claims and researches appropriate appeal steps
- Collect required documentation, review file documentation, and make sure all items needed are requested
- Ensure that all claim documentation is complete, accurate, and complies with company policy
- Establish, maintain, and update files, databases, records, and other documents for recurring internal reports
- Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials
- Contact and communicate with clients by telephone, e-mail, or in-person
Health Concierge
Bswift
11.2020 - 11.2021
- Demonstrates appropriate customer care behaviors (empathy, active listening, courtesy, politeness, helpfulness, etc.)
- Records, investigates and identifies profiles to determine appropriate action steps
- Logs, tracks, and appropriately documents interactions through utilization of call center technology
- Demonstrates and supports compliance to all policies and procedures
- Performs other duties as assigned
Health Advocate
United Health Group
10.2018 - 09.2020
- Assist customers in navigating uhc.com and other UnitedHealth Group websites while encouraging and reassuring them to becoming self-sufficient with our tools
- Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims
- Documents medical claims actions by completing forms, reports, logs, and records
- Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter
Customer Service Representative
Arise Virtual Solution / Ucare Communications/ Comcast
06.2018 - 09.2018
- Provided troubleshooting services regarding television and cable systems for customers
- Offer different service options to meet customer needs and financial situation
- Opened customer accounts by recording account information
- Maintains customer records by updating account information
- Resolved product or service problems by clarifying the customer’s complaint, determining the cause of the problem, selecting and explaining the best solution to solve the problem, expediting correction or adjustment, and following up to ensure resolution
- Worked to retain customers and provide upgrades to services, while de-escalating customer complaints
Retail Sales / Customer Service / Seasonal Position
Save Dollar Beauty Supply
08.2017 - 05.2018
- Greeted customers upon entering the store
- Stayed aware of the inventory available in the store
- Assisted in processing and replenishing merchandise
- Monitored floor stock and ensured establishment was clean and inviting
- Rang up sales at register and bagged merchandise
Customer Service Representative
Expert Global Solutions/Alorica
04.2016 - 05.2017
- Interacted with customers to resolve questions or concerns
- Responded to requests for assistance, and upsold products
- Tracked call-related information, maintained customer information, and provided feedback on call issues
Customer Service Representative
Conduit Global
10.2015 - 04.2016
- Created a positive atmosphere by smiling, greeting and providing a pleasant, friendly experience
- Proactively engaged customers in conversation about products and services
- Resolved customer issues and demonstrated understanding for customer situations
- Processed transactions quickly and without error while utilizing the computerized point of sale system to complete both credit and cash transactions
- Followed all policies as they related to data, procedures and cash handling
Cashier / Customer Service
Starbucks / Sodexo / UMW Dining
10.2013 - 10.2015
- Greeted customers and maintained a cheerful attitude towards customers
- Counted the money left in the drawer before starting the shift to ensure there were no discrepancies with respect to transactions of that day
- Managed the cash in the drawer, processed returns, and stayed aware of price of goods
- Understood and resolved customer complaints and responded to customer’s questions
Education
Bachelor's degree - Healthcare Management
American InterContinental University
08.2024
Associate of Science - Medical Billing and Coding
Ultimate Medical Academy
01.2018
Skills
- Electronic Health Records (EHR)
- Payment Posting
- Scheduling
- HIPAA
- Insurance Verification Insurance Claim Processing
- EOBs
- Co-Payments
- Deductibles
- Medical Billing
- Medical Coding
- ICD-9
- ICD-10 HCPCS
- CPT
- Medical Terminology
- Medicare, Medicaid and Tricare
- CMS1500
- CMS1450 (UB-04)
- Fee Schedules
- Public health
- Microsoft Word
- Accounting
- ICD Coding
- Medical Records
- Medical Office Experience
- Medical Scheduling
- EMR Systems
- Transcription
- Supply Chain & Logistics (3 years)
- Phone etiquette (10 years)
- Customer support
- Analysis skills
- Documentation review
- Leadership (5 years)
- Administrative & Business Operations (5 years)
- Administrative experience (3 years)
- EDI
- ICD-10
- Medical records
- Typing
- Customer service
- Medical terminology
- Medical coding
- ICD coding
- Leadership
- Research
- Working with people with developmental disabilities
- Medication administration
- Working with people with disabilities
- Healthcare Management
- Clinical Specialists
Certification
Driver's License
Timeline
Reimbursement Case Manager
Aston Carter
10.2023 - 01.2025
Medical PreCertification Specialist
Blue Cross Blue Shield
11.2022 - 10.2023
Part-time | Service Ambassador
Guilford Health Care Center
02.2022 - 06.2022
Enrollment Analyst
Change Healthcare
11.2021 - 06.2022
Health Concierge
Bswift
11.2020 - 11.2021
Health Advocate
United Health Group
10.2018 - 09.2020
Customer Service Representative
Arise Virtual Solution / Ucare Communications/ Comcast
06.2018 - 09.2018
Retail Sales / Customer Service / Seasonal Position
Save Dollar Beauty Supply
08.2017 - 05.2018
Customer Service Representative
Expert Global Solutions/Alorica
04.2016 - 05.2017
Customer Service Representative
Conduit Global
10.2015 - 04.2016
Cashier / Customer Service
Starbucks / Sodexo / UMW Dining
10.2013 - 10.2015
Bachelor's degree - Healthcare Management
American InterContinental University
Associate of Science - Medical Billing and Coding
Ultimate Medical Academy
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