Shakira Little
Burlington,NC
Summary
Experienced with denial management and claims resolution, ensuring accurate and timely claim processing. Utilizes analytical skills to identify and address root causes of denials, enhancing overall efficiency. Knowledge of industry regulations and best practices to maintain compliance and optimize revenue cycle performance.
Overview
10
10
years of professional experience
Work History
Claims/ Clinical Denial Specialist
Knowtion Health
Elon, NC
05.2023 - Current
- Scanned hard copy medical records and correspondence to convert into electronic files.
- Adjusted client accounts by entering discretionary billing items, requesting rebills and updating billing entity records.
- Reviewed provisions of certificates or policies to determine patient's medical coverage losses.
- Resolved medical claims by approving or denying documentation, calculating benefit due and initiating payment or composing denial letter.
- Determine and understand the coverage provided under a member’s health plan
- Efficiently use multiple systems and screens to obtain and record claim information
- Make claim payment decisions
- Process claims accurately to enhance customer satisfaction, and retention
- Process claims within quality and production standards
- Assist team members in support of achieving team, office, regional, and national goals
- Identify claims cost management opportunities and refer claims for follow up
- Review claims information to determine the nature of a members illness or injury
- Reviewed denial cases and coordinated appeals for optimal outcomes.
Release of Information Specialist
SCANSTAT
Elon, NC
09.2022 - 10.2023
- Streamlined extraction of protected health information through effective data management practices.
- Facilitated communication of patient information between caregivers and insurance entities.
- Analyzed and resolved medical record discrepancies by gathering relevant data.
- Managed phone communications from attorneys, insurance representatives, and patients professionally.
- Verified validity of medical record requests according to HIPAA and state laws.
- Employed EHR systems to efficiently locate requested patient information.
- Processed medical records for release while maintaining confidentiality standards.
- Tracked release activities in compliance with auditing requirements.
Medical Records Specialist
CIOX HEALTH, Health Information Management
Elon, NC
06.2017 - 06.2022
- Reviewed charts and flagged incomplete or inaccurate information.
- Processed medical records requests from outside providers according to facility, state, and federal law.
- Kept accurate log of requests for medical information and records.
- Uploaded physician progress notes, history, and physicals into electronic medical records.
- Created new medical records and retrieved existing medical records by gathering appropriate record folders and contents and assigning and recording new record numbers.
Dietary Technician
Liberty Commons
Burlington, NC
10.2015 - 03.2016
- Developed and implemented nutrition care plans.
- Participated in grant writing and research projects related to nutrition.
- Developed and implemented protocols related to nutrition care.
- Worked with insurance companies to obtain coverage for nutrition services.
- Educated patients and families on nutrition management.
Home Health Aide
Premier Home Health Services
Burlington, NC
04.2015 - 10.2015
- Assisted patients with dressing, grooming and feeding needs, helping to overcome, and adapt to mobility restrictions.
- Encouraged patients to participate in safe physical activity to help boost mood and improve overall wellness.
- Provided transportation and appointments management.
- Traveled to clients' homes to complete healthcare services and promote continuity of care.
Education
Associate of Science - Medical Office & Billing Specialist
Ultimate Medical Academy
Clearwater, FL09.2017
High School Diploma -
Western Alamance High
Elon, NC06.2009
Skills
- Payer relations in healthcare sector
- Medicare and Medicaid processes awareness
- HIPAA regulatory compliance
- Government payer engagement strategies
- Third-party payer management strategies
- Expertise in advanced EMR systems
Timeline
Claims/ Clinical Denial Specialist
Knowtion Health
05.2023 - Current
Release of Information Specialist
SCANSTAT
09.2022 - 10.2023
Medical Records Specialist
CIOX HEALTH, Health Information Management
06.2017 - 06.2022
Dietary Technician
Liberty Commons
10.2015 - 03.2016
Home Health Aide
Premier Home Health Services
04.2015 - 10.2015
Associate of Science - Medical Office & Billing Specialist
Ultimate Medical Academy
High School Diploma -
Western Alamance High