Summary
Overview
Work History
Education
Skills
Timeline
Generic

Shoyron M. Burns

Sacramento,CA

Summary

Knowledgeable and dedicated customer service professional with extensive experience in the healthcare industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.

Overview

19
19
years of professional experience

Work History

Claims Representative

Blue Shield of California
02.2022 - Current
  • Researches and responds to inquiries from beneficiaries and providers, such as benefits, claims, eligibility concerns, authorizations, etc; Handles escalated and high priority customer service issues; Resolves/de-escalates and/or escalates issues
  • Follows through with each issue to resolution by working with internal and external resources as needed; Receives calls for referrals and authorizations transactions, reviews documents, and modifies authorizations/referrals as prescribed by written procedures
  • Documents transactions in appropriate medical management systems; Processes additional assignments, such as primary care provider changes, address changes, ID card replacements; Writes responses to inquiries; Collects and tracks data regarding escalations so trends and issues can be identified or analyzed; Assists in training other Customer Service Representatives; Demonstrates regular, reliable and predictable attendance; Other duties as assigned.
  • Followed up with customers on unresolved issues.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • As Point of Contact, performed some interim supervisor duties.
  • Collaborated with management to develop strategic plans for continuous improvement and growth.
  • Assisted in the successful completion of projects by coordinating resources and providing support to team members.
  • Provided timely feedback on performance metrics, enabling employees to identify areas of improvement proactively.
  • Managed inventory effectively to prevent having out of compliance cases.
  • Championed change management initiatives by effectively communicating the benefits of new processes or systems, resulting in smoother transitions and increased adaptability among employees.
  • Evaluated employee performance and coached and trained to improve weak areas.
  • Boosted employee morale through effective communication, feedback, and recognition initiatives.
  • Co-trainer for new hires, Floor support and Assist Line, and Chat Support.

Customer Care Agent

Meridian Technologies
09.2019 - 02.2020
  • Researches and responds to inquiries from beneficiaries and providers, such as benefits, claims, eligibility concerns, authorizations, etc; Handles escalated and high priority customer service issues; Resolves/de-escalates and/or escalates issues
  • Follows through with each issue to resolution by working with internal and external resources as needed; Receives calls for referrals and authorizations transactions, reviews documents, and modifies authorizations/referrals as prescribed by written procedures
  • Documents transactions in appropriate medical management systems; Processes additional assignments, such as primary care provider changes, address changes, ID card replacements; Writes responses to inquiries; Collects and tracks data regarding escalations so trends and issues can be identified or analyzed; Assists in training other Customer Service Representatives; Demonstrates regular, reliable and predictable attendance; Other duties as assigned.
  • Responded to customer needs through competent customer service and prompt problem-solving.
  • Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
  • Educated customers about billing, payment processing and support policies and procedures.
  • Followed-through on all critical inter-departmental escalations to increase customer retention rates.

Medical Biller

Amerit Consulting
12.2018 - 07.2019
  • Assist beneficiaries as the beneficiaries telephone correspondence group; Gather information from beneficiaries, research/resolve inquiries and logged beneficiary calls; Check Medi-cal eligibility; knowledge of Medicare eligibility; review claims and authorization requests to answer beneficiary and providers concerns; check pharmacy claims; review claims and authorization requests to answer beneficiary and provider concerns; Communicate appropriate options for resolution in a timely manner; Inform beneficiaries about services available and assesses beneficiaries needs; Read and respond to emails in a timely manner; Stay current on Medical policies and procedures; Navigate various websites and use CRM and other software to perform duties according to the call
  • Assist providers with enrollment and other duties.
  • Reviewed patient records, identified medical codes and created invoices for billing purposes.
  • Managed billing calendar and scheduled claims for payments.
  • Liaised between patients, insurance companies and billing office.
  • Reviewed patient diagnosis codes to verify accuracy and completeness.
  • Collected payments and applied to patient accounts.
  • Prepared accounts with past due balances and transferred those cases to collection agency.
  • Posted payments and collections on regular basis.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Adhered to established standards to safeguard patients' health information.

Call Center Representative

TeleDirect
07.2015 - 03.2018
  • Promoted to Team Lead, D-Level and Expert; Provide professional customer service for many businesses in the U.S
  • And internationally; Answers and respond to in-bound calls for various companies
  • Act as an answering service for several companies including law offices, doctor offices, as well as dentist offices; Process auto, homeowners and general liability claims; Take online orders for several companies; Process donations, pledges for many different television networks; Ensure that all data is accurate and complete
  • Audit calls for accuracy and excellent customer service; Develop agents; Write and deliver evaluations; Ensure call center run in a smooth and efficient manner.

Call Center Representative

K- Designers
11.2014 - 02.2015
  • Answered and properly responded to in-bound phone calls via call center applications/systems; Successfully operated a PC, software/applications, telephone, fax, scanner and copier; Accurately documented in PC system the proper actions taken on each account; Demonstrated attention to detail; Achieved the determined production and quality expectations; Follows instructions and maintains workflow standards; Adheres to all company policies and procedures; Communicates effectively with staff and management at all times; Performs special projects as assigned.

Care Partner

Accentcare
05.2013 - 12.2014
  • Assistance with care of hair, teeth, dentures, shaving, filing of nails, other basic personal hygiene and grooming needs; Assistance with dressing and undressing, includes supervising the client when he/she can dress and undress when guided; Assisted the client to wash his or her body
  • Includes supervising the client when he/she can bathe him/herself when guided; Assistance with eating
  • Includes supervising the client when he/she is able to feed him/herself when guided; Assistance with bladder and/or bowel problems; Assisting the client to move around; Assisting the client to self-administer medications prescribed by his or her physician;
  • Assisting the client with exercises, skin care (including the application of ointments or lotion);
  • Accompanying or transporting the client to a physician’s office or clinic in the local area; Assistance with preparing meals; Assistance with household tasks essential to the client’s health and comfort.

Paraeducator Assistant/ Youth Leader

Markham Elementary
09.2011 - 04.2013
  • Present and prepare lesson plans as required; instruct individuals and small groups of students in academic areas; assist in the planning, implementation and documentation of a developmentally appropriate program for children; ensure and maintain a safe, healthy and nurturing classroom environment; prepare materials that highlight the interests and development of the children; assist prepare ongoing records and assessments of children's development; maintain ongoing, open communication with parents and attend parent conference; participate in a multidisciplinary team approach; contribute to ongoing development and evaluation of school’s goals and objectives; able to bend and lift up to 50 pounds.

Medical Billing/Account Representative

Wittman Enterprises
09.2007 - 05.2010
  • Performed ambulance medical billing activities; handled multi-tasking activities in a fast-paced work environment; processed mail; utilized a telephone headset; managed calls in a systematic and professional manner; contacted interpreting services to communicate with language barrier patients; provided customer service; identified the purpose and processed member calls according to appropriate scripts; resolved customer inquiries, problems and complaints; handled inquiries from governmental agencies, insurance companies and medical staff; navigated between personal computer, mainframe and internet software; input account information; analyzed records for completeness and accuracy; researched and obtained missing information; compiled and maintained records; collaborated with specialized call center members; verified health insurance information; handled unpaid claims; met quotas and deadlines; filed and maintained records; Knowledge of HCPCS, CPT, ICD-9 and Revenue coding, medical terminology and HIPAA regulations
  • Knowledge of HMO, PPO’s,Work Comp, Medicare and Medical, and various other insurance companies.

Inventory Specialist

Washington Inventory Service
10.2006 - 05.2007
  • Received training in the operation of inventory counting equipment; read and interpreted maps to store locations being inventoried; traveled as necessary in Northern California and Nevada; maintained good customer relations; followed verbal and written instructions; worked as part of a team taking inventory in stores; ensured all merchandise was accounted for and maintained a clean, orderly and safe workplace; performed numerical entry; utilized good time management skills to adhere to daily schedules.

Supervisor/Store Manager

Harman-Lathrop & Pacific, Lathrop
11.2004 - 08.2006
  • Oversaw restaurant operations; interviewed, hired, trained and supervised employees; maintained good public and employee relations; delegated employee workload; ensured safety policies and procedures were complied with; maintained quality control; met production quotas; rewarded production and morale; provided customer service; handled currency transactions; handled catered orders; inventoried and ordered supplies; received and verified shipments.
  • Conducted inventory analysis to determine optimal stock levels.
  • Answered product questions and assisted customers in selection and checkout.
  • Kept documentation and records accurate and up-to-date with latest data to prevent errors in processing or delivery.
  • Supervised associates by providing direction and instruction for stocking shelves, rotating stock and receiving deliveries.
  • Answered questions about store policies and addressed customer concerns.
  • Maintained customer satisfaction with quick and professional handling of product returns.
  • Liaised with store manager to set up visually appealing layout for store merchandise.
  • Boosted sales by effectively cultivating customer rapport and delivering superior customer service.
  • Reviewed daily financial records and reports and identified deficiencies in need of attention.
  • Walked through department multiple times each shift to evaluate and correct issues such as cleaning and stock replenishment needs.
  • Effectively allocated tasks during high-traffic times to keep operations running smoothly and employees focused.

Education

Banking & Financial Coursework -

Lindberg Adult School
Manteca, California

Instructional Assistant Paraeducator Certification - Early Childhood Education

Alameda County Office of Education
Oakland, CA

IC3 Certification - Information Technology

The Stride Center
Oakland, CA

Business Management Coursework - Business Administration And Management

Humphreys College
Stockton, CA

Diploma - General Studies

Calla High School
Manteca, CA

Skills

  • Ambulance/Medical Billing
  • Overseeing Restaurant Operations
  • Operating as a Team Member
  • Strong Communication
  • Interviewing/Hiring Employees
  • Multi-tasking Abilities
  • Strong Problem Solving
  • Training/Supervising Employees
  • Customer Service
  • Good Time Management Skills
  • Meeting Production Quotas
  • Handling Insurance Inquiries
  • Shift Scheduling
  • Inventory Management
  • Delegation and Supervision
  • Employee development
  • Time management
  • Adaptability
  • Staff training
  • Team building
  • Inventory Control
  • Training and Mentoring
  • Employee Motivation
  • Team Collaboration

Timeline

Claims Representative

Blue Shield of California
02.2022 - Current

Customer Care Agent

Meridian Technologies
09.2019 - 02.2020

Medical Biller

Amerit Consulting
12.2018 - 07.2019

Call Center Representative

TeleDirect
07.2015 - 03.2018

Call Center Representative

K- Designers
11.2014 - 02.2015

Care Partner

Accentcare
05.2013 - 12.2014

Paraeducator Assistant/ Youth Leader

Markham Elementary
09.2011 - 04.2013

Medical Billing/Account Representative

Wittman Enterprises
09.2007 - 05.2010

Inventory Specialist

Washington Inventory Service
10.2006 - 05.2007

Supervisor/Store Manager

Harman-Lathrop & Pacific, Lathrop
11.2004 - 08.2006

Banking & Financial Coursework -

Lindberg Adult School

Instructional Assistant Paraeducator Certification - Early Childhood Education

Alameda County Office of Education

IC3 Certification - Information Technology

The Stride Center

Business Management Coursework - Business Administration And Management

Humphreys College

Diploma - General Studies

Calla High School

Similar Profiles

CREATE PROFILE
Shoyron M. Burns