Summary
Overview
Work History
Education
Skills
Work Availability
Timeline

Cynthia Shields

Medical Claims Processor / Appeals Specialist
Phoenix,AZ
The real test is not whether you avoid this failure, because you won’t. It’s whether you let it harden or shame you into inaction, or whether you learn from it; whether you choose to persevere.
Barack Obama

Summary

Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Overview

8
8
years of professional experience

Work History

Rework Specialist

CVS/Aetna
WFH
11.2021 - Current
  • Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
  • Processed claims for payment or forwarded to appropriate personnel for further investigation
  • Inputted data into the system, maintaining accuracy of provider coding information and reported services.
  • Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
  • Accurately processed large volume of medical claims every shift.
  • Based payment or denials of medical claims upon well-established criteria for claims processing.

Correspondence Specialist II

Maximus
WFH
07.2021 - 10.2021
  • Answered inbound email inquiries regarding CDC updates about: COVID-19, Delta or the Omicron variant
  • Gathered data to formulate appropriate replies for information requests.
  • Composed letters and electronic correspondence.

Appeals Processor

Advanced Reimbursement Solutions
Scottsdale, AZ
10.2018 - 06.2021
  • Prepared and reviewed insurance-claim forms and related documents for completeness.
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
  • Assisted providers with problems or questions regarding claims.
  • Checked documentation for appropriate coding, catching errors and making revisions.

Insurance A/R Specialist

American Vision Partners
Phoenix, AZ
04.2018 - 10.2018
  • Resolved routine and complex issues by performing detailed research.
  • Managed denials, late payments, extensions and other special circumstances by following up with relevant parties.
  • Collaborated with carriers to resolve discrepancies in insurance payments.

Medical Biller/Appeals Representative

MBMS, thru Aerotek
Scottsdale, AZ
04.2017 - 03.2018
  • Filed and submitted insurance claims.
  • Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Contacted insurance providers to verify insurance information and obtain billing authorization.
  • Completed and submitted appeals for denied claims.
  • Submitted appeals using provider portals and phone communication.
  • Documented and filed patient data and medical records.

Appeals Specialist

Adreima, thru Aerotek
Phoenix, AZ
11.2016 - 01.2017
  • Acted as intermediary between insurance companies and patients by researching and assessing information to determine claim validity.
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
  • Assisted providers with problems or questions regarding claims.
  • Processed claims for payment or forwarded to appropriate personnel for further investigation

Patient Financial Services Representative

Banner Health
Mesa, AZ
07.2015 - 11.2016
  • Contacted insurance companies to check status of claim payments.
  • Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
  • Performed administrative functions for assigned accounts, recorded address changes and purged records.
  • Wrote appeal letters to insurance companies for denial of claims.
  • Arranged debt repayment or established schedules for repayment based on customer's financial situation.

Education

Certificate of Pharmacy Technician -

Downtown Phoenix College, Phoenix, AZ
12.2012

High School Diploma -

Dobson High School, Mesa, AZ
06.1992

Skills

  • Attention to Detail
  • Medical Terminology
  • Insurance Claims Processing
  • HIPAA
  • Insurance Plan Verification
  • Medicaid Knowledge
  • Organizing and Prioritizing Work
  • Microsoft Office
  • Data Entry
  • Critical Thinking
  • Decision-Making
  • 10-Key Touch
  • Insurance Claims Management
  • Claim Validity Determination
  • Analytical and Critical Thinking
  • Multitasking Abilities
  • Problem-Solving
  • Flexible and Adaptable
  • MS Office
  • Dependable and Responsible
  • Organization and Time Management

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse

Timeline

Rework Specialist - CVS/Aetna
11.2021 - Current
Correspondence Specialist II - Maximus
07.2021 - 10.2021
Appeals Processor - Advanced Reimbursement Solutions
10.2018 - 06.2021
Insurance A/R Specialist - American Vision Partners
04.2018 - 10.2018
Medical Biller/Appeals Representative - MBMS, thru Aerotek
04.2017 - 03.2018
Appeals Specialist - Adreima, thru Aerotek
11.2016 - 01.2017
Patient Financial Services Representative - Banner Health
07.2015 - 11.2016
Downtown Phoenix College - Certificate of Pharmacy Technician,
Dobson High School - High School Diploma,

Similar Profiles

CREATE PROFILE
Cynthia ShieldsMedical Claims Processor / Appeals Specialist