Open To Work
Shannon Phillips
Humana
Paramount
Work Preference
Desired Job Title
Network Operations Coordinator IVPhysician AdvocateCare Management Associate / Service Consultant / Customer Service
Location Preference
RemoteHybridOn-Site
Location:
Paramount, CALos Angeles, CA
Open to relocation:
No
36
years of professional experience
Seasoned healthcare operations professional with over 25 years in customer service, provider relations, claims resolution, and compliance. Demonstrates strong analytical skills and effective communication, fostering collaboration across diverse organizations. Proven expertise in enhancing service delivery and operational efficiency in government and healthcare settings.
Work History
Network Operations Coordinator IV
7 Years- Provided operational support and resolved complex issues for providers and clients in high-volume environment, enhancing service reliability
- Provide operational support and resolve complex issues for providers and clients within a high-volume environment
- Research and resolve claims, contract discrepancies, and service issues with accuracy and professionalism
- Researched and resolved claims, contract discrepancies, and service issues with accuracy and professionalism, ensuring client satisfaction
- Collaborated with multiple departments to streamline service delivery and enhance client outcomes
- Communicate effectively with diverse populations, ensuring clarity in services, procedures, and issue resolution
- Maintain strict confidentiality when handling sensitive client, provider, and contractual information
Physician Advocate
14 Years- Acted as the primary point of contact for providers and client groups, addressing concerns and resolving service issues
- Built strong relationships with clients, medical groups, and internal teams
- Managed sensitive information with discretion to resolve claims, benefits, and contract-related inquiries efficiently
- Evaluated policies and procedures to facilitate timely problem resolution
- Cultivated strong relationships with clients, medical groups, and internal teams to enhance collaboration
Care Management Associate / Service Consultant / Customer Service
15 Years- Coordinated case intake and documentation for patient care management, ensuring accurate records for effective treatment planning
- Reviewed referrals and escalated complex cases to ensure timely support and resolution
- Supported communication between healthcare teams and clients
- Facilitated communication between healthcare teams and clients to enhance understanding and collaboration
- Worked with insurance carriers to obtain authorization approvals for medications, supplies and equipment.
- Provided customer service and claims assistance
- Performed accounting tasks and administrative support
- Executed data entry and managed records efficiently
- Collaborated with multidisciplinary teams to address complex health needs and develop tailored interventions.
- Mentored junior staff on best practices in case management, fostering professional growth and operational efficiency.
- Led initiatives to optimize care transitions, reducing hospital readmissions through effective follow-up strategies.
- Analyzed patient data trends to inform program improvements and enhance overall quality of care delivered.
- Advocated for patients' needs within healthcare systems, facilitating access to necessary resources and support services.
Education
Bachelor of Science - Africana Studies
Graduated with Honors
Skills
Claims Analysis
Provider Relations
Compliance
Regulatory analysis
Data Management
Microsoft Office Suite
Report Preparation
Financial Recordkeeping
Administrative Support
Provider Support
Relationship Management
Timeline
Network Operations Coordinator IV
Humana
01.2019 - 01.2026Read More
Physician Advocate
UnitedHealthcare
01.2005 - 01.2019Read More
Care Management Associate / Service Consultant / Customer Service
Aetna Healthcare & City of Compton
01.1990 - 01.2005Read More
California State University, Dominguez Hills
Bachelor of Science from Africana Studies
Read More