SHADERRICA JORDAN
York,South Carolina
Summary
Precise, efficient medical billing professional with over 3 years of experience in inpatient, outbound and physician medical billing. Specialize in filing accurate claims, adjusting rejected claims, and understanding insurance contracts, appeals,and EOBs. Expertise in quality control,reimbursement, and implementing improved processes to enhance of business, billing and medical records.
Overview
6
6
years of professional experience
Work History
Sr. Reimbursement Case Manager
UBC
02.2023 - Current
- Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer calls to drive first call resolution
- Provide insurance coverage, verification details prior authorization statues and alternate funding options for existing and newly launched products
- Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions
- Clearly communicate and educate customers on the results of the investigation
- Investigate and problem solve for patients experiencing escalated issues such as disadvantaged or complex access, savings card/copay card challenges or non-preferred formulary issues
- Where necessary, complete a benefit investigation, contact the HCP and/or patient or potentially the filling pharmacy or payor
- Quickly learn and execute business process and system changes for all drugs and channel sources as applicable
- Maintain an understanding of current business procedures, deviations, and case processing for all brands and channel sources for Insurance Specialist I role to support as needed
- Documents information in the appropriate system of record and formats
- Accurately communicate insurance details to HCP and patients via phone, other electronic communication methods and fax, as per established policies and procedures
- Provide insurance coverage, verification details prior authorization statues and alternate funding options for existing and newly launched products
- Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions
- Clearly communicate and educate customers on results of the investigation
- Quickly learn and utilize all internal and external electronic tools, communicate/collaborate with payors and providers to investigate insurance coverage efficiently
- Identify potential Adverse Event situations for reporting to
- Pharmacovigilance ensuring AbbVie meets FDA regulations
- Understand and comply with all required training, including adherence to federal, state, and local pharmacy laws, HIPAA policies and guidelines, and the policies and procedures of AbbVie
- Complete alli required training and perform all functions in the position (i.e., Role certification, product and disease overviews)
Patient Support Manager
Cardinal Health
06.2019 - 01.2022
- Receiving medical claims from Health Care Providers, Patients
- Submitting billing data and medical claims to insurance companies
- Processing data from medical coders, making sure claims get processed and paid, verifying insurance coverage, reviewing denied claims.
- Assisting patients with billing questions
- Making sure claims get processed and paid
- Ensuring each patient's medical information is accurate and up to date
- Preparing bills, invoices and document amounts due to medical procedures and services
Benefit Verification Specialist
Lash Group
09.2017 - 06.2019
- Accurately verified patient specific benefits and sensitive document specifics for multiple payer plans
- Reviewed patients benefits to ensure accuracy before providing information to providers Identified any coverage restrictions and details to expedite patients access to care
- Reported reimbursement trends or delays to management
- Remained in compliance with all
- HIPPA, privacy and confidentiality HIPAA standards
Education
York Comprehensive High School
York, SC05.2017
Skills
- Fast paced
- Team oriented
- Communication Skills
- Active listening
- Time management
- Creativity
- Customer service skills
- Adaptability
- Positive attitude
- Conflict resolution
- Problem solving
- Leadership
- Account Management
- Multi Tasking
Accomplishments
- Expertise in all aspects of medical billing including filing claims, refund requests, re-filing rejected claims, completing claims, adjusting underpayments.
Qualifications
- Payment assistance
- Co-pay card offers
Timeline
Sr. Reimbursement Case Manager
UBC
02.2023 - Current
Patient Support Manager
Cardinal Health
06.2019 - 01.2022
Benefit Verification Specialist
Lash Group
09.2017 - 06.2019
York Comprehensive High School
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