Shawn Williams
Springfield
Summary
Self-motivated healthcare administrator specializing in provider engagement and education. Experienced in developing training modules that enhance understanding of Medicare and Medicaid policies, while fostering strong relationships with healthcare professionals to improve service quality and consumer satisfaction.
Overview
14
14
years of professional experience
Work History
Provider Engagement Administrator II
Centene
Springfield
03.2024 - Current
- Cultivate strong partnerships with assigned providers
- Discussed quality initiatives with providers to identify bonus opportunities for assigned groups, ensuring no potential revenue was overlooked
- Designed monthly presentations for providers, focusing on upcoming alterations in billing and workflows.
Conducted provider meetings to outline and discuss important workflow modifications. - Updated provider profiles emphasizing issues and concerns relevant to assigned provider groups to ensure effective communication and support
Provider Specialist II
Centene
Springfield
08.2021 - 03.2024
- Maintain strong working relationships with assigned providers
- Coordinate weekly, monthly, and quarterly meetings with all providers to address current issues
- Send provider agendas and obtain medical records to support fulfillment of continuity of care program
- Communicate findings of claims research effectively to improve provider insight
Provider Network Consultant
Blue Cross Blue Shield
Springfield
06.2019 - 07.2021
- Lead training webinars and orientation programs tailored for new and established providers across commercial and Medicaid/Medicare healthcare systems
- Oversee all internal mailboxes, maintaining inventory at a sustainable level
- Partnered with department managers to resolve issues enhancing service delivery for internal and external partners
- Regularly secured exceptional employee satisfaction ratings on an annual basis
Provider Network Associate
Blue Cross Blue Shield
Springfield
02.2018 - 06.2019
- Manage the internal Provider Network Consultant mailbox promptly (sending cases for review within 1-2 business days after receipt)
- Develop standard operational procedures (SOPs) for department regarding essential daily systems
- Conduct training programs for Provider Network Consultants utilizing everyday tools to boost representative effectiveness in roles
- Provided Salesforce expertise to department, ensuring effective utilization of platform capabilities.
Trained team members on Salesforce functionalities to improve performance and efficiency.
Created comprehensive training documentation to aid in knowledge retention.
Led interactive training workshops, promoting user engagement and skill development.
Customer Advocate II (BlueCard)
Blue Cross Blue Shield
Springfield
09.2013 - 02.2018
- Effectively resolve general inquiry responses and claim adjustment requests promptly
- Deliver information and modify claims for both host and home situations across all 5 Blue Cross Blue Shield states
- Coordinate with providers on billing issues for members under different Blue Cross Blue Shield policies
- Efficiently convey messages to employees from different areas through written correspondence, emails, and phone calls
Customer Advocate (Provider Services)
Blue Cross Blue Shield
Springfield
03.2012 - 09.2013
- Provided accurate claim information to nationwide providers, enhancing their ability to process claims efficiently
- Provide eligibility and benefit information to IL, TX, OK, and NM providers
- Delivered concierge service to ensure customer satisfaction, fostering strong provider relationships
- Communicate verbally and in writing with other departments who are also under BCBS
Education
Diploma - General Studies
Springfield Southeast Highschool
Springfield01-2004
Skills
- Provider engagement
- Patient engagement
- Effective communication
- Team collaboration
- Proficient in Microsoft Office
- Problem solving
- Attention to detail
- Time management
- Leadership
- Public speaking proficiency
Timeline
Provider Engagement Administrator II
Centene
03.2024 - Current
Provider Specialist II
Centene
08.2021 - 03.2024
Provider Network Consultant
Blue Cross Blue Shield
06.2019 - 07.2021
Provider Network Associate
Blue Cross Blue Shield
02.2018 - 06.2019
Customer Advocate II (BlueCard)
Blue Cross Blue Shield
09.2013 - 02.2018
Customer Advocate (Provider Services)
Blue Cross Blue Shield
03.2012 - 09.2013
Diploma - General Studies
Springfield Southeast Highschool