Sha-Nika Chapman

• Accurately and efficiently reviews denied claim information using the payer’s explanation of benefits, website, and by making outbound phone calls to the payer’s provider relations department for multiple denial types, payers, and/or states
• Knowledge of HMO’s, PPO’s, EPO's, POS IPA's, MA, Medicare, Commercial and other third party payers
• Reviews and obtains appropriate information or documentation from claim re-submission for all denied services, per insurance guidelines and requirements
• Communicates with patients, insurance carriers, co-workers, centers, markets, referral sources and attorneys in a timely, effective manner to expedite the billing and collection of accounts receivable
• Documents all communications with coworkers, patients, and payer sources in the billing system
• Contributes to the steady reduction of the days-sales-outstanding (DSO), increases monthly gross collections and increases percentage of collections
• Prioritizes work load, concentrating on “priority” work which will enhance bottom line results and achievement of the most important objectives
• Contributes to a team environment
• Recognizes and communicates trends in workflow to departmental leaders
• Meets or exceeds RCM Quality Assurance standards
• Ensures timely follow-up and completion of all daily tasks and responsibilities

Prioritizes and responds to the client needs and task each day.
• Work on upper leadership special projects and meets deadlines as given.
• Train all incoming new hires on the systems and the "how to processes".
• Collaborates with other departments on how to improve and update current policies
and procedures.
• Develops training guides and training recordings on system functions and processes.
• Identifies payer trends and gather for mass appeals.
• Enters representatives daily production STATS.
• Assist with daily questions via email, teams chat, training recaps and conference calls.
• Contributes to special projects as needed.
• Shadows representatives to find ways to help improve workflow and achieve daily
production.
• Audits representatives accounts as a learning curve and to decrease future errors.
• Adheres to new payer guidelines and updates on a daily/weekly basis.
• Establishes ways to decrease AR.
• Communicates work goals and deadlines to employees to increase productivity and
meet project benchmarks.
• Delegates tasks to team members according to project requirements and employee
strengths.
• Resolves problems and escalated high-level issues to supervisor within established
timeframes.
• Administers and creates training and awareness presentations or materials

• Worked with management to standardize work flows and establish/improve
processes to promote efficiency and productivity.
• Ensured all incorrect charge and claim discrepancies are corrected.
• Correct clearinghouse rejections and payer rejections daily. Notify manager regarding
payer rejection trends. Reports to supervisor and manager any concerns or
discrepancies in a timely manner.
• Works where necessary to accomplish continuous flow of work within the
Department.
• Performed all other duties as assigned.
• Collaborated with the billing, coding, payment posting and/or business Office
Manager and insurance payers on denied and/or corrected claims. Reduce aged AR.
• Assisted coworkers with additional training where needed.

• Researched payer rules and regulations to maintain current payer knowledge.
• Identified payer trends.
• Resolved payer rejections and denials through the appeals process as or by corrected
claims resubmission required by each payer.
• Demonstrated the ability to properly research account issues, resulting in account
resolution.
• Established and maintain relationships with individual payer provider relations
representative(s) to resolve collection issues with patient accounts.
• Prioritized and work assigned projects to obtain prompt payment from payer.
• Demonstrated the ability to escalate problem accounts to upper leadership/
management as required by circumstances.
• Recorded information about financial status of customers and status of collection
efforts.
• Completed assigned trainings and Professional Development courses.
• Performed other duties as assigned.

• Primary functions are to review credit balance accounts, appeal denied and underpaid
claims.
• Issued refunds to patients and payers due to overpayments once verified by EOB and
payers' contract.
• Handled contracted and non-contracted; HMO, PPO, EPO, POS, Worker's Com, selfpay
and third party reimbursement issues.
• Collaborating with the biller and/or business Office Manager and insurance payers on
denied and/or corrected claims.
• Ensured payments by primary and secondary payers and/or self-pay patients are
accurate.
• Responsible for thorough and timely patient account follow up to ensure accurate
accounts receivable reporting.
• Mapped out accurate and timely follow up and resolution for all accounts receivable.
• Meeting and maintaining cash collection metrics and goals.
• Effectively and independently handles second level reimbursement issues, contracted
and non- contracted denials for serviced before and after procedures.
• Corrected rejected claims in Zirmed and resubmitted to payer(s).