Cierra Sheppard
@cierrasheppard
Experienced Appeals Analyst with a focus on operational improvements.
United StatesWhat I'm looking for
I am an experienced Appeals Analyst with over 6 years in the healthcare industry, known for my ability to resolve complex problems and enhance customer satisfaction. My career has been marked by a consistent track record of driving operational improvements and cost savings while increasing profits. I thrive in fast-paced environments and have honed my skills in managing member interactions effectively.
Throughout my career, I have held various roles that have equipped me with a comprehensive understanding of claims processing and reconciliation. At Centene Health, I successfully reviewed authorization-related claim denials, resolving an average of 50 claims per day while maintaining a low authorization error rate. My previous experience at Anthem Inc. involved analyzing provider requests and ensuring adherence to internal guidelines, which further solidified my expertise in medical coding and claims management.
I am passionate about leveraging my skills to contribute to a team that values operational excellence and customer satisfaction. I am committed to continuous improvement and look forward to bringing my analytical abilities and problem-solving skills to a new role.
Experience
Work history, roles, and key accomplishments
Bank Sales
USAA
Jun 2024 - Present (1 year 1 month)
Handled inbound member calls in a fast-paced contact center, applying strong time and call management skills to assist members with banking needs. Efficiently navigated multiple systems and programs while maintaining engaging member interaction across multiple channels.
Reconciliation Coordinator
Centene Health
Nov 2021 - Present (3 years 8 months)
Reviewed authorization-related claim denials to ensure claims were paying or denying appropriately, resolving at least 50 claims per day. Ensured providers were paid promptly to increase provider and member satisfaction, maintaining an authorization error rate of 1.85% or less.
Provider Pay Reconsideration Analyst
Anthem Inc
Nov 2011 - Present (13 years 8 months)
Reviewed and analyzed provider requests to investigate claim payment or denial outcomes, determining appropriate resolutions using strict adherence to internal guidelines. Worked with various departments to determine root cause and appropriate resolution, remediating impacted claims.
Provider Service Unit
Anthem Inc
Nov 2011 - Present (13 years 8 months)
Processed claims forms for payment, ensuring all information was supplied before eligible payments were made. Researched and analyzed claims to facilitate accurate and timely processing.
Provider Authorizations/Customer Care Representative
Anthem Inc
Nov 2011 - Present (13 years 8 months)
Initiated Emergent Inpatient/Newborn delivery and Observation authorizations, assisting members and providers with pharmacy inquiries using the Express Scripts system. Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, and eligibility.
Education
Degrees, certifications, and relevant coursework
Brandon High School
High School Diploma, General Studies
Completed high school education and received a diploma.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
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