Shonica Bustamante Email & Phone Number

Fresno, California, United States

Fresno, California

• Managed a total of 30 staff in various divisions of the Loss Prevention and Recovery Department, including employee management, hiring, employee evaluations, interdepartmental conflict resolution, and monitoring of productivity metrics.• Established policies and procedures and actively managed department segments devoted to payment integrity, claims negotiation, overpayment recovery, appeals, subrogation, fraud prevention, dialysis claim management, 1094/1095 ACA reporting, and complex stop-loss claim considerations. • Routinely collaborated with other department managers to implement new processes and procedures to improve services and increase revenue. • Managed communications with brokers and clients to improve relations and increase client retention, including resolution of complex claim issues.• Assisted in the development, testing, and implementation of a dialysis claim management program including: documenting policies and procedures; communicating with brokers and TPA clients; establishing work-flows and inter-department communications; training of staff, and supervising outreach to members for education purposes.

Fresno, California

Responsible for all front office duties including maintaining appointment scheduled for four doctors, patient referrals, insurance verification, monthly patient progress reports to insurance companies, multi line phones, and patient retention.

Fresno, California

Lead analyst; recovered overpaid dollars from various sources such as hospitals and providers through audits on processed claim; processed HMO medical claim; assisted customer service with incoming calls from members and providers.