Shamiar Wright
Houston,Tx
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
12
12
years of professional experience
Work History
Medical Insurance Billing Specialist Ll
Trinity Health
10.2020 - Current
- Utilize and apply industry knowledge to resolve new and aged accounts receivables by working various account types, including but not limited to: hospital and/or professional claims, governmental and/or non-governmental claims, denial claims, high priority accounts, high dollar accounts, reimbursements, credits, etc
- Communicate professionally (in all forms) with payer resources to include: websites/payer portals, email, telephone, customer service departments, etc
- Seek resolution to problematic accounts and payment discrepancies
- Prepare appeal letters for technical denials by accessing specific payer appeal forms, submitting appropriate medical documentation, and tracking appeal resolution
- Identify denials trends, root cause, and A/R impact
- Maintain professional communication with clients and team members through various channels
- Consistently meet or exceed department standards and guidelines
- Adhere to the HIPAA privacy and security regulations.
Healthcare Customer Service Representative
Kelsey Seybold Clinic
10.2017 - 10.2020
- Responsible for charge and payment entry within Electronic Health Record
- Schedule appointments for Patients
- Coordinates and clarifies with providers, when necessary, on information that seems incomplete or is lacking for proper account/claim adjudication
- Responsible for corrective, completing, and processing claims for all payer codes
- Analyze and interpret that claims are accurately sent to insurance companies
- Perform follow up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts identified through aging reports
- Process appeals online or via paper submission
- Assist in reconciling deposit and patient collections
- Assist with all billing audit related information
- Process refund
- Provides explanation of in and out of network benefits
- Provides excellent customer service to de-escalate irate patients
- Reviews payment posting and explanation of payments
- Reviews accounts thoroughly to ensure the patient was billed properly
- Sets up payment plans for patients
- Posts adjustments to self-pay accounts as needed
- Provides excellent customer service
- Performs other tasks as assigned by the Patient Financial Services Manager
- Performs outbound cold calls to collect on open balances
- Meet quality requirements of 95 or above each month
- Follow guidelines made by Penn Medicine.
Customer Service Representative
Aetna
03.2014 - 03.2017
- Processing a minimum of 70 claims daily
- Medicare crossover claims processing
- Medicaid claims processing
- DME Claims processing
- CPT code knowledge
- CMS 1500 And UB-04 Processing
- Maintaining a 99.9% quality score in order to meet department goals
- Manual Pricing experience
- Prior authorization Experience
- Claims workstation trained
- ICD9 and 10
- Corrected claims processing experience
- LTC claims processing experience
- Behavioral health processing knowledge
- Texas star plus knowledgeable
- Experienced creating Team score cards and Production reports
- Audit experience at the Tier 1 Level
- Knowledge Medicare / Medicaid rules and guidelines
- Managing of work queue (working cases simultaneously), detailed oriented and time management is imperative
- Expected to comply with the quality standards for all related work activities (i.e., turnaround time, productivity and quality expectations)
- Client and CMS interaction required.
Team Leader
UnitedHealth Group
11.2013 - 01.2014
- Understanding and staying informed of the changes with procedures, billing guidelines, and laws for specific insurance carries or payers
- Supervising teams of charge entry and collections personnel
- Claims submission and tracking
- Payment posting
- Actively follow up and collect on all electronic claims, including resolution of any billing errors assigned following established procedures
- Respond to correspondence from insurance carries
- Responsible for handing customer service issues in a timely manner per provider request
- Perform other duties as required.
Member Advocate
UnitedHealth Group
02.2012 - 11.2013
- Responsible for answering incoming calls from customers while ensuring a high level of customer service and maximizing productivity in an inbound/ Outbound customer call center environment
- Assist consumers with resolution to questions or concerns regarding their healthcare benefits coverage, prescriptions, benefit and eligibility, billing and payment issues, customer material requests, physician assignments, authorization for treatment and Explanation of Benefits (EOB)
- Meeting monthly statistical metrics set forth by company (Quality, Adherence, AHT)
- Communicate with other health related agencies and organizations as needed
- Cross trained to provide back up support for other customer service representatives when needed
- Operate multiple systems to perform tasks
- Knowledge of insurance
- Transportation Scheduling
- Appointment Scheduling
- Prior Authorizations
- Appeals and grievances
- Balance billing
- Facets, SharePoint, Care one, ICUE, Macess.
Education
High school diploma -
Cypress Ridge School
Houston, TX01.2011
Skills
- Typing 50 wpm Microsoft word , excel, power point QNXT (10 years)
- Facets,Macess,sharepoint, epic , cubs icd 9, idc 10, EMR, HEDIS GAPS, SCHEDULING, Peoplesoft, Careone Medicare and Medicaid Amerigroup BlueCross and BlueShield of Texas STAR STAR kids TXMMP OSHA and JCAHO
- Medical Billing
- Customer Service
- DME
- Call Center
- Gastroenterology
- Workers Compensation (2 years)
- Epic
- Icd 10
- HCPCS
- Disability
- Icd-10
- Advanced Excel
- Managed Care
- Billing
- Claims
- Accounts Receivable
- Collections
- Medical Terminology
- Microsoft Excel
- Data Entry
- Outlook
- CPT Coding
- Insurance Verification
- Medical Coding
- Laboratory Experience
- Medical Records
Work Authorization
Authorized to work in the US for any employer
Personal Information
Willing To Relocate: Anywhere
Timeline
Medical Insurance Billing Specialist Ll
Trinity Health
10.2020 - Current
Healthcare Customer Service Representative
Kelsey Seybold Clinic
10.2017 - 10.2020
Customer Service Representative
Aetna
03.2014 - 03.2017
Team Leader
UnitedHealth Group
11.2013 - 01.2014
Member Advocate
UnitedHealth Group
02.2012 - 11.2013
High school diploma -
Cypress Ridge School
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