Camry Shelby
Jackson,MS
Summary
I am seeking a position to secure a career opportunity where I can expand my training and skills, while making a significant contribution to the success of the company. I am very detailed-oriented and knowledgeable about automated systems and variations plan benefits.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Medical Claims Specialist
Pharmacyclics AbbVie Company
Chicago, IL
01.2023 - 01.2024
- Handled billing related activities focused on medical specialties.
- Reviewed claims for accuracy before submitting for billing.
- Precisely calculated refunds, premiums, and adjustments.
- Collaborated with fellow team members to manage large volume of claims.
- Conducted research into complex medical coding issues to ensure proper reimbursement.
- Collaborated with other departments regarding changes to existing processes and procedures.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Verified patient eligibility for medical claims and determined benefit coverage.
- Examined claims, records and procedures to grant approval of coverage.
- Resolved issues related to denied or underpaid claims in a timely manner.
- Sent clinical request and missing information letters to obtain incomplete information.
- Adhered to HIPAA regulations while managing confidential patient information.
- Documented file notes clearly and concisely in Salesforce & CRM data base.
- Maintained accurate records of all claim activities for audit purposes.
- Provided feedback on coding errors and discrepancies found in submitted claims.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Responded promptly to customer inquiries regarding claim status updates.
Caregiver
Kimmys Caring Healthcare
Jackson, MS
02.2015 - 01.2024
- Respected the rights of each individual client while maintaining confidentiality of all personal information.
- Participated in team meetings regarding client progress or concerns raised by family members.
- Assisted with ambulation by providing support during transfers from bed to chair or wheelchair.
- Monitored health and well-being of clients and reported significant health changes.
- Created safe and positive living situations for clients by communicating with family and other staff about concerns or challenges.
- Maintained clean and well-organized environment for client happiness and safety.
- Transported clients to doctor appointments and other errands using wheelchair accessible vehicles.
- Maintained accurate records of services provided, changes in client condition, medications administered and other pertinent information.
- Provided companionship for elderly clients by engaging in conversation and participating in recreational activities.
- Reported concerns to nurse supervisor to promote optimal care.
- Ensured compliance with all applicable laws, regulations and standards governing home health care services.
- Recorded client status progress and challenges in logbooks and reports.
- Assured proper nutrition by preparing meals, grocery shopping and monitoring food consumption levels.
Intake Surgery Coordinator
TurningPoint Healthcare Solutions
Lake Mary, FL
03.2020 - 10.2022
- Monitored compliance with regulations concerning authorization processes.
- Assisted customers with questions or problems related to their authorization requests.
- Worked with cross-functional teams to achieve goals.
- Created cases in salesforce and CRM data base for members and providers
- Answered 50 plus calls a day to assist members and providers
- Performed insurance verification.
- Ensured member authorizations are reviewed in timely manner.
- Participated in professional development activities related to case management best practices.
Enrollment Specialist
Healthfirst
Lake Mary, FL
10.2019 - 01.2020
- Coordinated with other departments to ensure timely processing of admission applications.
- Reviewed applications for accuracy before submitting them for approval.
- Explained coverage options to potential policyholders, answering questions or concerns.
- Handled new enrollments by entering customers' data and reviewing information.
- Transcribed data to worksheets and entered data into computer to prepare documents and adjust accounts.
Reimbursement Specialist
United BioSource Corporation
Lake Mary, FL
10.2018 - 09.2019
- Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
- Maintained a database of all reimbursements, payments, and other transactions.
- Fixed discrepancies in patient accounts
- Obtained benefits verification
- Made 15-30 calls per day based on case loads
- Navigated procedural documents while engaging with customers
- Transferred patient information from Excel spreadsheet onto software system.
Senior Customer Care Specialist
Humana
Jackson, MS
07.2016 - 08.2018
- Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
- Performed data entry, billing inquires, VOB.
- Responded to internal and external eligibility inquires.
- Performed services to 50-70 members per day.
- Navigated through procedure documents while engaging on the phone with members.
- Documented customer correspondence in CRM to track requests, problems and solutions.
- Utilized job-related software to prepare change of address records and issue service discontinuance orders.
Education
Associate of Arts - Clinical Psychology
Hinds Community College
Raymond, MS12-2023
High School Diploma -
Terry High School
Terry, MS05-2013
Some College (No Degree) - Medical Assisting
Delta Technical College
RidgelandSkills
- Provider Relations
- Interpersonal Abilities
- Insurance Verification
- Claims Processing
- Prior Authorization Processing
- Medicaid/Medicare/Tricare Knowledge
- Payment Posting
- Medical Billing
- Medical Coding
- HIPAA Knowledge
- Meticulous Recordkeeping
- Insurance Claims
- Medical Terminology
- Customer Service
- Quality Assurance Checks
- Proficiency in VLookup, CRM, SALESFORCE, EXCEL, ALL MICROSOFT 365, SQL, ZENDESK, SAS, PIVOT TABLES, GOOGLE SUITES, OUTLOOK
- Knowledgeable in EMR
- HIPAA
- Insurance Claims Processing
- ICD-9, ICD-10,
- Medical records keeping
Certification
- Medical Billing and Coding Certification
- CPR & First Aid Certification
- Register Health Information Certification
Timeline
Medical Claims Specialist
Pharmacyclics AbbVie Company
01.2023 - 01.2024
Intake Surgery Coordinator
TurningPoint Healthcare Solutions
03.2020 - 10.2022
Enrollment Specialist
Healthfirst
10.2019 - 01.2020
Reimbursement Specialist
United BioSource Corporation
10.2018 - 09.2019
Senior Customer Care Specialist
Humana
07.2016 - 08.2018
Caregiver
Kimmys Caring Healthcare
02.2015 - 01.2024
Associate of Arts - Clinical Psychology
Hinds Community College
High School Diploma -
Terry High School
Some College (No Degree) - Medical Assisting
Delta Technical College
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