Summary
Overview
Work History
Education
Skills
Timeline
Generic

SHAWHANA LANG

Sacramento

Summary

Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.

Overview

11
11
years of professional experience

Work History

Remote Referral Specialist

Chenega Corporation
03.2025 - Current
  • Called insurance companies to get precertification and other benefits information on behalf of patients.
  • Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.
  • Streamlined referral processes for increased efficiency, resulting in timely appointments for patients.
  • Verified insurance benefits and eligibility for TRICARE procedures before referring clients.
  • Managed high-volume referral requests by prioritizing tasks and maintaining organized records.
  • Reduced wait times for specialist appointments by diligently following up on pending referrals.
  • Acted as a liaison between referring physicians and specialists, establishing trust and rapport through professionalism.
  • Processed referral requests from patients, doctors and other health care professionals.
  • Assisted with completion of referral forms and verified data accuracy and completion

Appeals Grievances Specialist

Health Net Federal Services
07.2017 - 01.2025
  • Demonstrates regular, reliable and predictable attendance.
  • Ensures compliance with TRICARE regulations.
  • Researches and interprets TRICARE regulations to resolve appeals and grievances.
  • Documents the results of complaints and appeals.
  • Writes custom response letters to providers, beneficiaries and representatives.
  • Prepares case files for Medical Directors and Appeals RN for clinical determinations.
  • Prepares clinical complaint resolution letters under guidance of clinical staff.
  • Prepares case file review for the Defense Health Agency (DHA) and the TRICARE Quality Monitoring Contractor.
  • Prioritizes and handles escalated and high priority cases.
  • Contacts providers via phone and in writing to help research and resolve problems.
  • Works with subcontractors to get answers, re-do claims, follow up on problem resolution, etc.
  • Recommends operational and process improvements based on efficiencies and available technologies.
  • Other duties as assigned.

Intake Rep II

Health Net Federal Services
01.2016 - 07.2017
  • Auditor
  • Mentor new staff, provide chair side training, research using information within other fields for editing requests, retrieve documentation from subcontractor’s database.
  • Follows instructions, including redirecting patients into the provider network for care, per contractual standards.
  • Summarize referral/authorization requests and prepare correspondence to provide clinical information to servicing providers.
  • Maintain production reports on closed transactions, duplicate transactions and requests.
  • Work as a team member, collaborate with co-workers, and take responsibility for achieving outstanding customer service.
  • Review situations, objectively identify problems, recognize patterns and determine solutions.

Intake Rep I

Health Net Federal Services
03.2014 - 01.2016
  • Validates patient and medical provider demographic information including correct selection of a medical provider by specialty for healthcare service.
  • Determines whether patients are eligible to receive health care benefits under the insurance program by determining the patients’ status/eligibility, the Primary Care Manager type, and the appropriate referral/authorization path.
  • Contacts medical provider offices by telephone, and makes confirmation calls to patients for all urgent requests.
  • Follows step-by-step instructions, including redirecting patients into the provider network for care, as required by contractual standards.
  • Formulates brief sentences/paragraphs from referral/authorization orders and prepares correspondence in business letter format to provide clinical information to servicing providers.
  • Generates letters and reviews to validate that they are going to the correct providers/patients, and that the provider/patient demographics and reason(s) for services to be rendered are correct.
  • Accounts accurately for personal production via a production report that includes outcome data such as closed transactions, duplicate transactions and requests.
  • Meets goals and produces results through tracking performance, improving work processes, and prioritizing work and tasks.
  • Achieves successful solutions by reviewing situations and ensuring a full understanding before taking steps to resolve key components of this responsibility are objectively identifying problems, recognizing patterns, and determining solutions.
  • Works as a team member: cooperates, assists and collaborates with co-workers to achieve goals and department success, and takes personal responsibility for achieving outstanding customer service.

Education

Associate in Applied Science Degree - Medical Office Administration

Heald College
Roseville, CA
01.2014

Skills

  • Knowledgeable in insurance billing procedures and medical terminology
  • Ability to perform medical administrative tasks including transcription of medical documents
  • A team player ready to provide quality care and customer service to clientele
  • Competent with compliance to HIPAA standards and OSHA guidelines in a medical office
  • Give high priority to customer and company satisfaction
  • Problem-solving
  • Interpersonal skills
  • Empathy

Timeline

Remote Referral Specialist

Chenega Corporation
03.2025 - Current

Appeals Grievances Specialist

Health Net Federal Services
07.2017 - 01.2025

Intake Rep II

Health Net Federal Services
01.2016 - 07.2017

Intake Rep I

Health Net Federal Services
03.2014 - 01.2016

Associate in Applied Science Degree - Medical Office Administration

Heald College

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SHAWHANA LANG