R’Shea DuBar
Atlanta,GA
Summary
Detail-oriented and highly analytical Medicare Claims Specialist with extensive experience in claims processing, appeals management, and regulatory compliance within the healthcare and insurance sectors. Skilled in investigating, evaluating, and negotiating Medicare claims, ensuring adherence to CMS guidelines and state regulations. Proven ability to mentor teams, optimize workflows, and improve claims accuracy, reducing errors and increasing efficiency. Adept at utilizing Electronic Medical Records (EMR), Medicare Claim Reporting Tools (MCRT), and medical terminology to assess claims and resolve disputes. Committed to delivering exceptional customer service, minimizing risk exposure, and driving process improvements in Medicare claims management.
Overview
23
23
years of professional experience
Work History
Licensed Medicare Claims Specialist
STATE FARM INSURANCE
01.2023 - Current
- Investigates and negotiates ligation within Medicare lien demands.
- Assisted with implementation of department Standard Claim Process (SCP)
- Improved team morale and productivity by fostering collaborative work environment as diversity and inclusion team lead.
- Accurately completes Medicare Claim Reporting Tool (MCRT).
- Delivered comprehensive training sessions for new hires on claims handling procedures, policy interpretation basics, negotiation techniques, and other core competencies related to the role of a Claims Specialist.
Licensed Property Claims Specialist
STATE FARM INSURANCE
04.2022 - 12.2022
- Analyzed policy coverage/endorsements for insured to establish complex liability'
- Investigative contact attempts with insureds, witnesses, other insurance agencies, medical providers and police officers.
- Consort with attorneys to negotiate claim settlements, lawsuits and arbitrations
- Provided expert consultation to policyholders regarding coverage options, guiding them towards informed decisions about their property protection needs.
Licensed PIP/MPC Claims Associate
STATE FARM INSURANCE
08.2019 - 03.2022
- Identify eligible parties for coverage, analyze medical bills, subrogation opportunities, and expense claims submitted for payment.
- Participated in cross-functional projects and initiatives, leveraging claims expertise to support company-wide objectives.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Calculated adjustments, premiums and refunds.
Licensed Claims Adjuster
STATE FARM INSURANCE
03.2017 - 07.2019
- Enhanced company reputation by demonstrating professionalism and empathy during interactions with policyholders in difficult situations.
- Analyze information gathered by investigation of claims while abiding by state jurisdictional statutes, and establish liability
- Incorporated service level objectives to achieve action plans and strategies.
- Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
Administrative Clerk
Mercer University Atlanta Office Of Career Management
02.2016 - 08.2016
- Entered data into the system and updated customer contacts with information to keep records current.
- Maintained a professional office environment by ordering necessary supplies, managing inventory levels, and organizing workspaces.
- Reduced errors in data entry tasks by maintaining accurate records and utilizing verification methods.
- Supported auditors by efficiently compiling requested documentation.
Advertising Sales Coordinator
COX MEDIA GROUP (AJC)
04.2005 - 10.2014
- Managed a diverse portfolio of clients, maintaining strong relationships and providing exceptional customer service.
- Maintained 50+ clients in partnership with 6 Account Executives (portfolio of 500k+)
- Developed customized media plans based on client objectives, utilizing various platforms to reach target audiences effectively.
- Coordinated cross-functional teams involved in executing advertising campaigns from inception through completion.
- Developed and maintained a comprehensive database of prospective clients, using effective follow-up techniques to convert leads into paying customers with Salesforce.
Sales & Operations Manager
HOMETOWNE SUITES
02.2002 - 01.2003
- Managed, motivated, and regimented 8 person staff, prepared schedules, monitored PTO and benefits
- Coordinated all accounts receivable/payable, direct bills & monthly budget expenses
Education
MBA - Healthcare Management
12-2022
Bachelor of Science - Healthcare Administrative Management
Associate of Arts - Healthcare Administration/Medical Records
Skills
- Electronic Medical Record (EMR)
- Spreadsheet/Database Creation
- Conflict Resolution
- Medical Terminology / Billing
- Microsoft office suite
- Compliance management
- Complex claims analysis
- Teamwork and collaboration
- Time management
- Adaptability and flexibility
- Multitasking
- Medicare Part A, B, C, D compliance & regulations
Medical Skills And Competencies
- Operational Support
- Microsoft Office Suite
- Healthcare Information Technology
- Report & Document Preparation
- Electronic Medical Record (EMR)
- Spreadsheet/Database Creation
- Monitoring Budget
- Conflict Resolution
- Client Relations
- Scheduling
- Medical Terminology
- Medical Billing
- Salesforce.com
- Purchase Orders
Timeline
Licensed Medicare Claims Specialist - STATE FARM INSURANCE
01.2023 - Current
Licensed Property Claims Specialist - STATE FARM INSURANCE
04.2022 - 12.2022
Licensed PIP/MPC Claims Associate - STATE FARM INSURANCE
08.2019 - 03.2022
Licensed Claims Adjuster - STATE FARM INSURANCE
03.2017 - 07.2019
Administrative Clerk - Mercer University Atlanta Office Of Career Management
02.2016 - 08.2016
Advertising Sales Coordinator - COX MEDIA GROUP (AJC)
04.2005 - 10.2014
Sales & Operations Manager - HOMETOWNE SUITES
02.2002 - 01.2003
SHORTER UNIVERSITY - MBA, Healthcare Management
UNIVERSITY OF PHOENIX - Bachelor of Science, Healthcare Administrative Management
UNIVERSITY OF PHOENIX - Associate of Arts, Healthcare Administration/Medical Records
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