CASHAY HILLS
Remote
Summary
Detail-oriented Revenue Cycle and Coding Denial Specialist with over 7 years of experience in resolving coding denials and optimizing reimbursements. Proficient in CPT, ICD-10-CM, and HCPCS coding alongside payer policies, ensuring compliance with industry regulations. Expertise in analyzing medical records and managing write-offs to enhance productivity in remote environments.
Overview
12
12
years of professional experience
Work History
Claims Charge Correction Specialist
Advocate Health
08.2024 - 10.2025
- Enhanced reimbursement accuracy by resolving coding edits and claim denials.
- Ensured compliance with coding guidelines and payer policies effectively.
- Processed charge corrections and patient balance transfers in Epic systems.
- Maximized reimbursements through timely resubmission of corrected claims.
- Identified denial trends and escalated coding discrepancies to leadership efficiently.
- Achieved productivity benchmarks while maintaining quality in a remote environment.
Managed Care Follow-Up Representative
Advocate Health
02.2024 - 08.2024
- Enhanced claim resolution by addressing coding-related and service denials.
- Facilitated clean claim resubmissions through thorough analysis of documentation.
- Resolved complex billing issues via effective communication with payers and teams.
- Monitored payer trends impacting reimbursements, providing actionable insights to management.
Referral Specialist Lead
Centene Corporation
04.2022 - 12.2023
- Improved coding accuracy by reviewing medical documentation for authorizations.
- Verified benefits and eligibility through efficient payer portal utilization.
- Enhanced workflow accuracy by leading team training initiatives and quality standards.
- Ensured HIPAA compliance while managing sensitive clinical information securely.
Referral Coordinator Team Lead
Rush University Medical Center
11.2019 - 03.2022
- Streamlined workflows, aligning prior authorizations with CPT and diagnosis codes.
- Increased approval rates by ensuring accuracy of reimbursement documentation.
- Trained staff in payer guidelines, enhancing quality reporting and compliance.
Benefits Advisor | Contact Center Lead
Health Benefits Representative
01.2014 - 01.2019
- Extensive experience working with Medicare, Medicaid, and commercial payers on claims and benefits inquiries.
- Strong foundation in healthcare compliance, documentation, and customer communication.
Education
Medical Billing & Coding Degree -
Ultimate Medical Academy
07-2026
High School Diploma - undefined
Michigan City High School
06.2010
Skills
- Coding Denial Resolution & Appeals
- Pre-Bill Coding Edits Review
- CPT, ICD-10-CM, HCPCS, NDC
- Medicare, Medicaid & Commercial Payers
- Payer Portals & Policy Interpretation
- Charge Corrections, Write-Offs & Transfers
- Medical Record Review & Documentation
- Productivity & Quality Metrics
- HIPAA & Confidentiality Compliance
- Epic EHR proficiency
Timeline
Claims Charge Correction Specialist
Advocate Health
08.2024 - 10.2025
Managed Care Follow-Up Representative
Advocate Health
02.2024 - 08.2024
Referral Specialist Lead
Centene Corporation
04.2022 - 12.2023
Referral Coordinator Team Lead
Rush University Medical Center
11.2019 - 03.2022
Benefits Advisor | Contact Center Lead
Health Benefits Representative
01.2014 - 01.2019
High School Diploma - undefined
Michigan City High School
Medical Billing & Coding Degree -
Ultimate Medical Academy