Danielle Shaw
Gering,NE
Summary
To secure and manage/administrative position with a growing organization. Where I can assist patients and co-workers with day-to-day tasks. I would love to work with a team in a fast-paced environment. I am focused on patient care and quality of care. To utilize my knowledge and experience of the coordination of a medical office.
Overview
20
20
years of professional experience
Work History
Senior Provider Documentation Specialist
Robert Half
03.2023 - Current
- Provided correction, editing and updating contracts between medical facilities and United Healthcare
- Read and edit documents to the specs from requesting agencies
- Maintained and tracked over one thousand contracts using the CLM management system
- Used brightree and x-author for building templates and contracts as requested
Plan Document Specialist/Claim Examiner
Regional Care Incorporated
08.2021 - 07.2022
- Examined claims for error
- Verified and reprocessed corrected claims
- Called providers and or patient with claim concerns for processing
- Reported errors to providers offices and kept running knowledge of patients claims that were and was not in processing sessions
- Used ICD-9/10 Knowledge for issues with claims and concerns with providers
Patient Financial Specialist
Cheyenne Regional Medical Center
05.2015 - 07.2017
- Provided exemplary customer service while working with patients and/or guarantors, and insurance companies appropriately concerning billing issues
- Submitted all claims, both electronically and hard copy, in a timely manner
- Worked assigned aging reports weekly
- Verification and posting of all payments and adjustments in a timely manner
- Provided feedback to management regarding edits nonresolution’s billing editors, and or process improvements to remove barriers for complete and accurate account resolution
- Able to evaluate payer remits and denials for accuracy according to individual contracts and pursue reimbursement on accounts with general understanding of CPT, HCPCS, ICD-9 and revenue codes
- Knowledge of general insurance laws, guidelines and contract language, specializes in TRICARE and Veteran Affair benefits
- Knowledge of Medicare, Medicaid, and extremely knowledgeable of all commercial insurance programs, including Medicare HMOs and state programs to include filing deadlines, billing requirements, and reimbursement methods
- Also was the sole direct contact for Cheyenne Regionals Crime Victims Program
- Ability to utilize critical thinking skills to reconcile accounts in a timely manner composed and submitted appeals to third party payers, appealing to the highest level to resolve account denial for proper reimbursement
- Single Billing Office Duties i.e
- Answering incoming calls for patients that needed answers to their medical billing concerns, payments arrangements and making payments
Military Police Officer
United States Air Force
11.2004 - 12.2012
- Maintained operations for the Commander's office including all office duties
- Trained and qualified on multiple weapons such as M16, M4, M240B, M249, M-9 and the M203
- Responsible for Security of Nuclear Weapons Systems PL1 resources
- Patrolled with military vehicles for investigating, arresting and charging criminals
- Responded to emergency situations
- Trained and supervised troops on the rules and regulations of Air Force
- Provided traffic control and crowd control
- Operated security check points/providing premise and entry security
- Provided vehicle dispatching duties in the Security Forces Vehicle Section
- Maintained sole responsibility for over 1500 troops weapons qualifications in a database system
- Complete Airman Leadership School for training to become rank of Non-Commissioned Officer
- Scheduled and assisted in fingerprint
- Scheduled fingerprints for fellow troops
- Inprocessed new troops
- Collected all needed information in process while directing new troops to new areas of work and appointments
- Taught classes for new Airmen to learn how to process and welcome to the police unit
- (Orientation courses)
Education
Bachelor of Arts - Healthcare Administration
University of Arizona Global Campus
Remote06.2021
Associates of Occupational Studies - Allied Health, Medical Billing and Coding
IBMC COLLEGE
Cheyenne, WY03.2015
Skills
- Editing and proofreading
- API documentation
- Adobe creative suite
Timeline
Senior Provider Documentation Specialist
Robert Half
03.2023 - Current
Plan Document Specialist/Claim Examiner
Regional Care Incorporated
08.2021 - 07.2022
Patient Financial Specialist
Cheyenne Regional Medical Center
05.2015 - 07.2017
Military Police Officer
United States Air Force
11.2004 - 12.2012
Bachelor of Arts - Healthcare Administration
University of Arizona Global Campus
Associates of Occupational Studies - Allied Health, Medical Billing and Coding
IBMC COLLEGE
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