Shani Stewart
DOVER
Summary
Professional with robust experience in customer service, focused on analyzing and improving service quality. Skilled in identifying trends, implementing effective strategies, and ensuring compliance with standards. Strong emphasis on team collaboration and adaptability, consistently achieving impactful results. Known for critical thinking, problem-solving abilities, and effective communication.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Provider Data Analyst - Subject Matter Expert/ Team Lead
United Healthcare
05.2023 - Current
- Enhance data accuracy by implementing rigorous quality assurance processes and procedures.
- Optimize provider network performance by conducting regular audits and addressing discrepancies in a timely manner.
- Train and mentor staff to ensure data integrity and compliance with organizational and regulatory standards
- Improved team productivity by 30% in the last quarter of 2024
- Evaluate and refine operational processes to improve turnaround times and enhance standard operating procedures
- Conduct daily coaching sessions for individuals and groups to assist with quality improvement and retention of processes
Senior Provider Data Specialist
United Healthcare
09.2021 - 05.2023
- Conducted peer reviews and audits to confirm adherence to Medicare and Medicaid compliance standards
- Analyzed and executed provider contracts with precision, maintaining strict compliance with regulations
- Identified areas for process improvement within the Provider Data Specialist role, implementing solutions that drove operational excellence.
- Enhanced provider data accuracy by conducting thorough audits and reviews of the database.
Clinical Administrative Coordinator
United Healthcare
12.2016 - 09.2021
- Responded to patient inquiries via phone and email, providing accurate information and resources while maintaining a professional demeanor.
- Coordinated prior authorization requests, ensuring accurate triage for medical procedures
- Verified ICD-10 and CPT codes to maintain billing accuracy and compliance
- Managed case review documentation for clinical directors and processed notifications for services
- Supported clinical staff by coordinating schedules, handling appointment confirmations, and updating patient records as needed.
Provider Services Representative
United Healthcare
01.2013 - 12.2016
- Analyzed and rectified claim discrepancies to guarantee precision in payment decisions
- Communicated with providers regarding claim updates and benefit eligibility
- Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns
- Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters
- Interpreted and relayed member benefit and eligibility information accurately, leveraging both internet and intranet resources for verification
Loan Servicing Specialist
Wells Fargo Home Mortgage
11.2009 - 01.2011
- Provided expert guidance on mortgage modification and financing options, leading the resolution of customer complaints
- Coordinated point-of-sale lending and managed diverse financial products, ensuring client comprehension
- Advised clients on mortgage modification and financing solutions, ensuring comprehensive understanding of available options
- Addressed and resolved customer inquiries and issues, surpassing company benchmarks for production, quality, and adherence to schedules
Medical Administrative Assistant Volunteer
Brain Injury Association of MD
06.2009 - 11.2009
- Managed the digitization of case records, ensuring accurate and expedient data entry to streamline file accessibility
- Developed and disseminated correspondence and informational materials to engage volunteers and donors effectively
- Digitized case records to enhance data management processes
- Created and disseminated communication materials, fostering engagement with volunteers and donors
- Eased patient anxiety during visits through empathetic communication skills and attentive listening abilities.
Education
Bachelor’s Degree - Applied Management
Grand Canyon University
Associate’s Degree - Applied Science - Advanced Medical Billing and Coding
Lincoln College of Technology
Skills
- HIPAA compliance
- Group Facilitation
- Conflict De-escalation
- Problem Solving
- Medicare and Medicaid Compliance
- Technical Issue Resolution
- Microsoft Office Suite
- Customer Service
- Multi-tasking
- Time Management
- Clear and concise communication
- Data quality assurance processes
Certification
Certified Lean Six Sigma Yellow Belt, Six Sigma Global Institute
Timeline
Provider Data Analyst - Subject Matter Expert/ Team Lead
United Healthcare
05.2023 - Current
Senior Provider Data Specialist
United Healthcare
09.2021 - 05.2023
Clinical Administrative Coordinator
United Healthcare
12.2016 - 09.2021
Provider Services Representative
United Healthcare
01.2013 - 12.2016
Loan Servicing Specialist
Wells Fargo Home Mortgage
11.2009 - 01.2011
Medical Administrative Assistant Volunteer
Brain Injury Association of MD
06.2009 - 11.2009
Associate’s Degree - Applied Science - Advanced Medical Billing and Coding
Lincoln College of Technology
Bachelor’s Degree - Applied Management
Grand Canyon University
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