Shadiamond Wilson
Columbiana,AL
Summary
Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
9
9
years of professional experience
Work History
Healthcare Specialist
Provider Resources LLC
Erie, PA
08.2025 - Current
- Reviewed 25+ dispute submissions daily and supporting documentation to determine the prevailing party in compliance with Federal IDR regulations.
Evaluated clinical records, billing data, and statutory factors to support accurate and defensible payment determinations.
Maintained thorough case documentation to ensure audit readiness and adherence to federal compliance and quality standards.
Trained and mentored new analysts on evidence review protocols, regulatory requirements, and documentation best practices.
Eligibility Analyst
C2C INNOVATIVE SOLUTIONS INC
07.2024 - 08.2025
- Reviewed approximately 30 dispute cases per day for eligibility under the Federal IDR process by verifying required notices, timelines, documentation, and Explanation of Benefits (EOBs) prior to acceptance.
Analyzed clinical records, CPT codes, QPA calculations, and payment histories to support accurate and compliant reimbursement determinations.
Maintained comprehensive case files to ensure audit readiness, regulatory compliance, and adherence to federal reporting standards.
Identified submission deficiencies and workflow gaps to reduce avoidable disputes while mentoring new analysts on review protocols, quality standards, and documentation requirements.
Claims Associate
RI Rcm
06.2021 - 07.2024
- Efficiently process claims, ensuring timely reimbursements and minimal errors.
- Conduct thorough reviews of claim documentation to reduce processing times.
- Collaborate with healthcare providers to resolve claim issues and enhance communication.
- Maintain accurate records for compliance and improved audit readiness.
Provider Claim Resolution Specialist
Blue Shield
Birmingham, AL
12.2018 - 05.2021
- Resolved complex provider claims efficiently, leading to substantial improvements in claim processing time and enhanced provider satisfaction.
- Provided exceptional customer service to providers, addressing inquiries with empathy and professionalism to build lasting relationships.
- Provided guidance and training to new team members, cultivating a collaborative environment that promoted knowledge sharing and team growth.
- Developed a feedback loop with providers, enabling continuous improvement in service delivery and addressing concerns proactively.
Mobile Expert
Tmobile
Birmingham, AL
11.2016 - 12.2018
- Advised customers on mobile solutions, enhancing satisfaction and driving measurable sales growth.
- Resolved technical issues, improving customer retention and service efficiency.
- Educated customers on mobile technology, leading to noticeable improvements in user experience and a stronger customer base.
- Analyzed customer feedback to identify service gaps, implementing solutions that enhanced satisfaction and loyalty.
Education
Associate of Science - Legal Studies
Faulkner University
Montgomery, AL09.2025
High Diploma -
Huffman High School
Birmingham, AL05.2013
Skills
- Insurance Collections
- Patient Billing
- Microsoft Excel
- Claims Processing
- Team Leadership
- Microsoft Office
- Document Review
- Decision Making
- Excel
- Patient confidentiality
Websites
Timeline
Healthcare Specialist
Provider Resources LLC
08.2025 - Current
Eligibility Analyst
C2C INNOVATIVE SOLUTIONS INC
07.2024 - 08.2025
Claims Associate
RI Rcm
06.2021 - 07.2024
Provider Claim Resolution Specialist
Blue Shield
12.2018 - 05.2021
Mobile Expert
Tmobile
11.2016 - 12.2018
Associate of Science - Legal Studies
Faulkner University
High Diploma -
Huffman High School
Links
LinkedIn