Kelli Q Shavers
Plano,TX
Summary
Seeking a great company where I can utilize my skills and professionalism. I have exceptional ability to understand the healthcare industry and would like to bridge that experience and knowledge to develop professional growth in the insurance industry.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Medical Billing Analyst
Homecare Homebase
02.2020 - Current
- Processing, monitoring, and collecting of Home Health/ Hospice Medicare, Medicaid and other commercial insurance claims in accordance with payor requirements
- Verifying accuracy of billing data and revising any errors
- Identify contracting errors/billing errors. Identify discrepancies, such as denied claims, underpaid claims, or differences in reimbursement
- Creating and distributing various financial reports as needed
- Timely resolution of all claims including appeals
- Following up on accounts for billing and on overdue accounts for collections via phone calls, re-submissions and adjustments for billing errors
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Verified insurance of patients to determine eligibility.
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
- Audited and corrected billing and posting documents for accuracy.
Appeal Analyst/ Neonatal Govt. Collector
Pediatrix Medical Group
01.2017 - 01.2020
- Current responsibilities include conducting billing and Collecting on all commercial and Govt accounts greater than 90 days
- Along with analyzing and managing accounts to provide feedback to management
- I identified trends, audit accounts and forward findings to the Director along with make credit balance adjustments and initiate refunds meeting departmental productivity standards
- Ensures that claims are processed accurately through review and audit functions to ensure timely payment
- Responds to inquiries regarding claims with under payment or non-payment
- Responds to inquiries, questions, and concerns from patients regarding the status of claims in a clear, concise, and courteous manner
- Interfaces with external and internal customers to ensure optimal efficiency of service
- Monitors aging of claims to ensure timely follow-up and payment.
Reconciliation Specialist
Addison Group/ Pinnacle Partners
09.2016 - 01.2017
- Successfully reconciled outstanding deposits to balance financial records identifying issues attributing to account delinquency and communicate with management and billing department when necessary the collection and follow-ups
- Resolve all variances before final processing of claims.
Senior Revenue Appeals Analyst
CCS Medical
07.2013 - 03.2016
- Responsible for claims submission and claims resolution for insulin and non-insulin dependent patients in regards to Medicare patient accounts
- Made corrections if needed, review audits, begins the refund processes
- Collaborated daily with the teams on the productivity output along with the projected dollars
- Successfully corrected accounts receivable issues
- Collected and communicated with all clinical and IT departments for adding, deleting, changes and updates in the company database, including the CMS and AMA codes updates
- Work with government and commercial payers and payer guidelines
- Initiate contacts and negotiate appropriate resolution (internal and external)
- Receive and resolve inquiries and correspondence from third parties and patients
- Researching accounts and refiling or appealing claims
- Submitting additional medical documentation and tracking account status by monitoring and analyzingassigned unresolved third party accounts
- Conducted ongoing file reviews with the supervisor.
Senior Commercial Collector
Christus Healthcare
08.2012 - 07.2013
- Responsible for billing, collections and reimbursement services of Workers’ Compensation claims to hospitals
- Ensured that all claims are billed and collected meet all government mandated procedures for integrity and Compliance
- Demonstrated a level of accountability to ensure data and codes are not changed on claims prior to submission if related to diagnosis, charge and other clinical type data
- Coordinated training classes and quality assurance for the revenue cycle department along with policy compliance with Federal (CMS) and State Regulations (HSCRC)
- Ensures all Compliance errors are reported to the Director and maintain records and files of documentation supporting bill changes that are directed by Director and/or Integrity Officer
- Used logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.Communicated with claimants, providers and vendors regarding claim issues
- Managed medical treatment and medical billing, authorized as appropriate based on the claims handling guidelines.
Medical Billing/Sr. AR Specialist
Tenet Healthcare/ Conifer Health Solutions
10.2007 - 07.2012
- Performed task as follows:
- Successfully managed desk- and caseload of at least 55– 65 commercial claims in an efficient and professional manner
- Maintained accounts receivable/billing to ensure that all claims are billed properly and free from errors
- Analyzed and produce data, reviewed trending issues for procedures and identified areas for improvement
- Accurately checked and invoiced endorsements and attached insurance policies to the company database, reviewed premium rates, Audits accounts to ensure all demographic, insurance payer information and signatures are required and documented correctly
- Collected on outstanding balances due from third party carriers in a timely fashion
- Investigate claims thoroughly, including coverage, liability, denials, appeals and overpayment
Insurance Verification Trainer/Coordinator/Sr. Collector
Baylor Surgicare
11.2004 - 09.2007
- Knowledge of Commercial insurance policies, applications, endorsements and insurance proposals .and performed the following task
- Billing and collection of Workers’ Compensation accounts
- Contact insurance companies to determine when payments will be made and if additional information is needed for processing payments and claims
- Trained all new employees on Front Office procedures and job responsibilities, Reviewed monthly reports from the insured/ checked the rates and premiums, secure pre certifications and authorizations prior to surgeries
- Assisted patients in applying for financial assistance and or hardships
- Receive and process invoices, code invoices and perform other account payable duties.
Education
BACHELORS OF SCIENCE - HEALTHCARE ADMINISTRATION
UNIVERSITY OF PHOENIX
MEDICAL OFFICE PRACTITIONER PROGRAM-CERTIFICATION -
X-RAY -
RICHLAND COLLEGE
BUSINESS APPLICATION SPECIALIST PROGRAM- CERTIFICATE - Business Administration
Richland College
Dallas, TX08.1996
Skills
- Skills and Highlights:
- Licensed All Lines Adjuster
- Experienced with both Self and fully insured Benefit Plans
- EDI Billing
- Reimbursement Management
- Critical Thinking
- Medicare and Medicaid Processes
- Medical Billing and Collections
- Billing Codes
- Customer Service
- CPT Code Modifiers
- Reviewing Patient Information
- HIPAA Compliance
- ICD-10 Coding
- Claims Review
- Tracking Spreadsheets
- Insurance Claims
- Medical Coding Knowledge
- Microsoft Office Package
- Medical Records Security
- Verbal and Written Communication
- Medical Billing Technology
- Accounts Receivable Management
- ICD-9
- ICD-10
- Training and Development
- A/P and A/R Expertise
- Diagnostic Codes
- Time Management
- Client Inquiries
- Workers' Compensation license
- Insurance Collections
- Payments Posting
- Waystar
- Emdeon
- SMS
- Reimbursements
- Credentialing Data Coordination
- Provider Enrollment Expertise
- Strong Communication Skills
- NextGen
- MediSoft
- Cerner
- RealMed
- All Scripts
- Power Point
- Excel
- McKesson
- GE Healthcare
- E Clinical Works
- Advanced MD
- Xisin
Certification
Fluent in Medical Terminology including ICD9/ICD10 CPT coding-Certificate Knowledge of Computers in Healthcare-Certificate Medical Assisting and Patient Care Management-Certificate Radiography Training, Radiation Safety, Radiological Equipment, Safety Operation and Maintenance/Image Production and Evaluation Microsoft Office Package CPR & First Aid Certified- American Heart Association
Licensed Workers compensation All Lines Adjuster
Six Sigma Trained
Timeline
Medical Billing Analyst
Homecare Homebase
02.2020 - Current
Appeal Analyst/ Neonatal Govt. Collector
Pediatrix Medical Group
01.2017 - 01.2020
Reconciliation Specialist
Addison Group/ Pinnacle Partners
09.2016 - 01.2017
Senior Revenue Appeals Analyst
CCS Medical
07.2013 - 03.2016
Senior Commercial Collector
Christus Healthcare
08.2012 - 07.2013
Medical Billing/Sr. AR Specialist
Tenet Healthcare/ Conifer Health Solutions
10.2007 - 07.2012
Insurance Verification Trainer/Coordinator/Sr. Collector
Baylor Surgicare
11.2004 - 09.2007
BACHELORS OF SCIENCE - HEALTHCARE ADMINISTRATION
UNIVERSITY OF PHOENIX
MEDICAL OFFICE PRACTITIONER PROGRAM-CERTIFICATION -
X-RAY -
RICHLAND COLLEGE
BUSINESS APPLICATION SPECIALIST PROGRAM- CERTIFICATE - Business Administration
Richland College
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