Shameka Nelson
North Charleston,SC
Summary
I'm a current student looking to join the workforce to gain real-world experience. A focused student with knowledge of customer and patient service, data entry, and records management. Aiming to leverage my abilities to successfully fill the vacancy on your team. Frequently praised as detail-oriented by my peers, I can be relied upon to help your team achieve its goals. Hardworking professional with 5 years of experience and proven knowledge of back office operations, administrative support, and customer service. Aiming to leverage my abilities. Detail-oriented professional with experience in records management, customer service and various computer software programs related to the position including, Cerner, Citrix, Athena, EPIC, Brightree, Cleo, Pioneer RX and Microsoft Office Suite applications. I am an adaptable professional with years of work experience and proven knowledge of executive support, staff training and development, and workflow prioritization. Ambitious individual with strong organizational and multitasking skills, as well as an aptitude for technology. Ready to apply knowledge and skills to any challenge.
Overview
5
5
years of professional experience
Work History
Accounts Receivable Clerk
Floyd Brace Company Inc
North Charleston, SC
05.2023 - 07.2023
- Sent copies of invoices and statements to customers to facilitate payment of outstanding invoices.
- Monitored accounts receivable report, checking for late, delinquent, or missing invoices and payments.
- Entered, posted and scanned accounts receivable documents into accounting software.
- Processed monthly payments and researched payment discrepancies.
- Ensuring that all services provided are authorized by reviewing the status of medical claims, researching and re-billing unpaid claims.
- Applying patient payments, electronically or over the phone, posting refunds, adjustments and collections assistance as needed.
- Worked closely with internal teams to resolve customer billing and payment issues.
Prior Authorization Representative
Blue Sky Specialty Pharmacy
Mount Pleasant, SC
03.2023 - 04.2023
- Navigated through computer screens to complete and review documents and other forms.
- Reviewed clinical documents such as progress notes, labs, radiology reports to verify accuracy and completeness of documentation before processing request for authorization.
- Reviewed medical records thoroughly before submitting them for pre-authorization review process.
- Successfully processed and obtained authorization for medical services requested by providers in a timely manner.
- Processed urgent requests within specified timeframes in order to provide immediate care for patients in need
- Adhere to HIPAA regulations while maintaining confidentiality of patient information at all times.
- Actively participated in educational meetings regarding new changes or updates made by insurance companies concerning prior authorization requirements as well as regular meetings with management team providing feedback on current trends in the industry
Financial Counselor
MUSC Orthopedics
Mount Pleasant, SC
11.2022 - 02.2023
- Educated patients about health care financing options such as Medicaid or Medicare programs for those who may qualify.
- Assessed eligibility for charity care programs according to established criteria.
- Maintained knowledge of community services and resources available to patients.
- Maintained a high level of confidentiality when dealing with sensitive medical records or financial information.
- Reviewed medical necessity denials from third-party payers and appealed them when appropriate.
- Resolve any patient complaints regarding billing or payments in a prompt manner.
- Review EOB statements from insurance companies to verify coverage and eligibility status.
- Coordinated communication between patients, family members, medical staff administrative staff, or regulatory agencies.
- Utilized excellent communication skills when interacting with patients, families, physicians, staff members and third-party payers.
Radiology Scheduler
East Cooper Medical Center
Mount Pleasant, SC
02.2022 - 11.2022
- Met needs of physicians and other treating team members with timely retrievals of patient medical records.
- Assigned patients to diagnosis-related groups using Cerner, Citrix and Fax-com software.
- Performed administrative duties such as filing paperwork, answering phones, and responding to emails in a professional manner.
- Demonstrated expertise in scheduling radiology appointments, coordinating with medical staff and patients to ensure timely service delivery.
- Displayed proficiency in using various computer software programs related to the position including Microsoft Office Suite applications.
- Actively participated in educational seminars and webinars related to radiology scheduling best practices.
- Identified, compiled, abstract and code patient data, using standard classification systems.
- Collaborated with physicians, nurses, and other healthcare providers to ensure the accuracy in availability for scheduling and of patient information in the system.
- Retrieved patient medical records for physicians, technicians and other medical personnel.
- Identified potential conflicts between scheduled appointments and addressed them quickly.
Patient Access Representative
Insight Global
Charleston, SC
01.2022 - 02.2022
- Applied HIPAA privacy and security regulations while handling patient information.
- Verified demographics and insurance information to register patients in computer system.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
- Registered patients by completing face-to-face interviews to obtain demographic, insurance and medical information.
- Obtained necessary signatures for privacy laws and consent for treatment.
- Communicated financial obligations to patients and collected fees at time of service.
- Applied knowledge of payer requirements and utilized on-line eligibility systems to verify patient coverage and policy limitations.
- Assembled registration paperwork and placed identification bands on patient.
Medical Billing and Collections Specialist
XIFIN
Daniel Island, SC
07.2021 - 12.2021
- Took billing calls, questions and concerns from patients and third party carriers.
- Processed claims and forwarded information to Medicare, Medicaid and commercial insurance companies.
- Entered patient charges and payments into electronic health records.
- Performed data entry of patient demographic information into EMR software.
- Prepared itemized statements, bills, and invoices, and record amounts due for services rendered and items purchased.
- Identified, evaluated and resolved reasons for delinquency to reduce loss to medical facility.
- Provided training and guidance to new staff members on collection procedures.
- Made outbound calls to negotiate plans with patients to ensure timely debt repayment.
- Research discrepancies between billing statements and insurance payments
Collections Representative
MUSC Health
Charleston, South Carolina
09.2019 - 05.2021
- Reasoned with customers and attempted to negotiate full balance payments.
- Handled irate customers smoothly to achieve performance targets.
- Used effective questioning techniques to clarify why debtors were delinquent.
- Managed approximately 60 inbound and 35 outbound calls daily.
- Remained calm, stayed professional and provided exceptional service on calls, even when interacting with difficult individuals.
- Received payment and posted to appropriate customer accounts.
- Processed payments over phone and set up recurring drafts.
- Notified customers of delinquent accounts with attempt to collect outstanding amounts.
- Recorded and updated customer personal accounts with accurate contact information.
- Reviewed accounts to determine payment plan compliance.
- Displayed proficiency in using various computer software programs related to the position including, EPIC and Microsoft Office Suite applications.
Patient Access Representative
Change Healthcare, A McKesson
North Charleston, SC
07.2018 - 06.2019
- Applied HIPAA privacy and security regulations while handling patient information.
- Verified demographics and insurance information to register patients in computer system.
- Organized and maintained records by updating and obtaining both personal and financial information from patients.
- Obtained necessary signatures for privacy laws and consent for treatment.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Answered inbound calls, chats and emails to facilitate customer service.
Education
Certificate - Phlebotomy
Phlebotomy Training Specialist
North Charleston, SC08.2023
High School Diploma -
Burke High School
Charleston, SC06.2009
Skills
- Insurance Verification
- Team Collaboration
- Phone and Email Etiquette
- Invoice and Payment Processing
- Data Entry
- Advanced Clerical Knowledge
- Multi-Line Phone Proficiency
- Insurance Processing
- Insurance Eligibility
- Cerner, Citrix, Athena, EPIC, Brightree, Cleo, Pioneer RX and Microsoft Office Suite applications Program Proficiency
- Basic Medical Terminology
- Verbal and Written Communication
- HIPAA Compliance
- Insurance Billing
- Understanding of Dental Insurance
- EMR
- Patient Education
- Problem-Solving
- Team Leadership
- Insurance Company Knowledgeable
- Appointment Scheduling
- Patient Registration
- Typing 50 wpm
- Insurance claims
- Medical office administration
- Outpatient care
- Electronic Medical Records
- Patient Scheduling
- EMR / EHR
- Reminder calls
- Payment collection
- Google Workspace
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
If one is lucky, a solitary fantasy can totally transform one million realities.
Maya Angelou
Timeline
Accounts Receivable Clerk
Floyd Brace Company Inc
05.2023 - 07.2023
Prior Authorization Representative
Blue Sky Specialty Pharmacy
03.2023 - 04.2023
Financial Counselor
MUSC Orthopedics
11.2022 - 02.2023
Radiology Scheduler
East Cooper Medical Center
02.2022 - 11.2022
Patient Access Representative
Insight Global
01.2022 - 02.2022
Medical Billing and Collections Specialist
XIFIN
07.2021 - 12.2021
Collections Representative
MUSC Health
09.2019 - 05.2021
Patient Access Representative
Change Healthcare, A McKesson
07.2018 - 06.2019
Certificate - Phlebotomy
Phlebotomy Training Specialist
High School Diploma -
Burke High School
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