Misty Sexton
Mount Airy,NC
Summary
Organized and reliable candidate equipped with strong organizational skills and a commitment to achieving team objectives. Capable of managing multiple projects with precision and a positive attitude. Eager to contribute to a dynamic team in a full-time position, leveraging interpersonal abilities, time management, and problem-solving skills.
Overview
18
18
years of professional experience
Work History
Insurance Specialist Patient Financial Services
Novant Health, Inc
Winston-Salem, North Carolina
02.2025 - Current
- Processed Medicaid and managed care claims with precision, ensuring compliance with regulations.
- Obtained authorizations from Medicaid and managed care plans promptly to facilitate timely billing.
- Accurately coded claims, ensuring compliance with regulatory standards and minimizing claim denials.
- Conducted follow-ups on medical bill statuses through calls to payers, ensuring timely resolution of claims and payments.
- Monitored outstanding invoices and executed collections, improving cash flow and reducing outstanding debt.
- Generated monthly billing and posting reports for management review and analysis.
Medicaid Specialist
Northern Hospital of Surry
Mount Airy, North Carolina
04.2022 - 09.2024
- Handled all Medicaid and managed care plan claims, ensuring compliance with regulations.
- Obtained authorizations from Medicaid and managed care plans, streamlining claim processing.
- Resolved denied claims through adjustments, securing necessary approvals.
- Coded claims meticulously to support accurate processing and reimbursements.
- Audited and corrected billing documents for accuracy, ensuring integrity of financial records.
- Produced monthly billing reports for management review, supporting informed decision-making.
- Monitored outstanding invoices, executing collections duties to enhance cash flow.
- Utilized data entry skills to document statements accurately and efficiently.
Designated Employee Representative
Pike Electric
Mount Airy, North Carolina
07.2012 - 07.2020
- Managed drug testing for pre-employment, random, reasonable suspicion, and follow-up testing to ensure compliance with regulations.
- Coordinated DOT Clearinghouse tasks to ensure regulatory compliance and facilitate communication among stakeholders.
- Verified that all employees were current on all DOT requirements, testing and certifications.
- Oversaw substance abuse professional program setups and maintained ongoing communication with SAP for effective program implementation.
- Scheduled DOT physicals for employees.
- Consulted with outside professionals and specialists about tests and testing results.
Insurance Billing Clerk
Northwest Medical Partners
Mount Airy, North Carolina
08.2008 - 07.2011
- Processed account payments and communicated details of outstanding balances.
- Tracked outstanding invoices and executed collections activities.
- Reviewed and rectified billing and posting documents to ensure accuracy.
- Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
- Maintained accurate records of customer payments.
- Used data entry skills to accurately document and input statements.
Education
High School Diploma -
North Surry High School
Mount Airy, NC06-1997
Some College (No Degree) -
Surry Community College
Dobson, NCSkills
- Claims processing
- Claims adjudication
- Authorization management
- Medical coding
- Procedure coding
- ICD-10
- Regulatory compliance
- Insurance Verification
- Billing management
- Accounts receivable
- Medical Records
- Client Documentation
- Office Operations
- Claim documentation
- ICD-10
Timeline
Insurance Specialist Patient Financial Services
Novant Health, Inc
02.2025 - Current
Medicaid Specialist
Northern Hospital of Surry
04.2022 - 09.2024
Designated Employee Representative
Pike Electric
07.2012 - 07.2020
Insurance Billing Clerk
Northwest Medical Partners
08.2008 - 07.2011
High School Diploma -
North Surry High School
Some College (No Degree) -
Surry Community College