SHAMIKI CARR
Concord,CA
Summary
Accomplished administration with eight years of experience working in fast-paced medical industry positions, emphasizing efficient processes, productive operations, and superior service to internal and external customers. Innovative, self-motivated professional who creates solutions for clients, colleagues, and the organization.
Overview
19
19
years of professional experience
Work History
Associate Claims Examiner
CEI Center: for Elders Independence
10.2021 - 09.2022
- EDI claims such as - Lando, Lumino, Change Healthcare, Office Ally, Lumina, Mckesson, VitaL Link, Medline, High dollar claims - I process them through the Web Pricer, make a report / packet then submit them to the department physician for approval
- Upon approval I apply the payment and approve the claim
- Manage the following provider account types: Acupuncture and International Effectiveness Interpreters
- Enter the following claims manually
- Adjust for various fields and specialties i.e Medical, Dental, Dialysis
- Meals on Wheels, State Serve and Share File
- Knowledge Of All claim processes for multiple insurances and provider types
- I.e Medicare, HMO, PPO, SNF, Hospice etc.
- Utilize all Fee schedules such as but not limited to: Medicare, SNF, Ambulance, Diagnostic labs, FSSA Rates
- Generate weekly financial reports for payroll of claim revenue followed by a check-run.
- Communicate with various Providers and Vendors via email and telephone.
- Process new and edit existing W-9's through the Great Plane operating system.
- Filing, Heavy data - entry, High Volume Phones
- Assist with the Appeals, RCFE process, ECW and Helix Accounts
- Databases utilized are: EZ Cap, EZ Net, Coreftp, E Clinical Works, ESMGR 212, CMS Web pricer (inpatient/outpatient), ESRD PPS PC Pricer
Medical Biller in then Posting Department
BASS Medical Group
04.2018 - 11.2019
- Posts payments based on explanation of benefits (EOBs) from insurance companies and government agencies
- Post patient payments in a timely manner to the appropriate line-item charge.
- Posts payments and adjustments in a while communicating payment variances from third-party and government agency payers to the Posting Supervisor
- Perform batching and reconciliation workflow.
- Research and resolves “unapplied and/or unidentified” payments to ensure monies are properly distributed.
- Processes zero pay EOBs & refers them to appropriate resources for follow-up and resolution.
- Perform other duties as assigned by management.
- Epic/ Apex, All Scripts
Medical Billing Follow-up Representative
BASS Medical Group
04.2018 - 11.2019
- Reviewed missing or incomplete documentation.
- Provided proper coding on provider documentation.
- Maintained timely follow up on outstanding insurance claims.
- Effectively took appropriate action on claim denials to ensure prompt resolution and follow up on claims that are rebilled, corrected and/or appealed.
- Maintained detailed documentation on software system (EPIC) on all claims and collection activities, included but not limited to rebilling, follow up and related correspondence with carriers, patients, referring offices and other sites.
- Responsible for patient billing inquiries, delinquent patient balances and questions regarding insurance coverage
- Followed all regulations and guidelines set by Medicare and State programs.
Medical Biller Externship
Allergy & Weight Loss/Endocrinology Center
07.2018 - 08.2018
- Printed & processed insurance claims.
- Posted payments, denials, process authorizations, run payments, correct payments for (CCHP) Contra Costa Health Plan
- Processed & posted insurance and patient payments.
- Posted bulk checks.
- Insurance verification and customer eligibility
- Inputted allergy injections into the system
- Processed superbills; denials; UMR (United healthcare payments)
- Created encounters on patient pay-log.
- Front office duties: answered phones, sorted incoming/outgoing mail, fax, copy, scan.
School Bus Driver / Student Monitor / School Bus Aid
Antioch School District
07.2013 - 04.2017
- Maintained order among pupils during class and in route to their destination.
- Completed daily log and vehicle inspection, while providing excellent customer service
- Transported school-aged children to and from home, school, and therapies.
Operations Route Clerk / School Bus Driver
Durham/Peterman Transportation Services
09.2005 - 04.2010
- Performed administrative duties within the Operations Department
- Completed daily log and vehicle inspection, while providing excellent customer service
- Transported school-aged children to and from home, school, and therapies.
Medical Administrative Asst. / Medical Biller / File Clerk
Kelly Temporary Services UCSF Campus
01.2004 - 01.2005
- Assisted patients with registration, client billing, and chart assembly.
- Performed insurance billing, submitted claims, filing, answering multi-line phones, facsimile, mail distribution and data-entry.
Education
Medical Billing and Coding Cohort program -
San Francisco State University & Jewish Vocational Services (JVS)
San Francisco, CABilling and Coding CPC Review program -
Martinez Adult Education Center
Martinez, CAMedical Administrative/Billing & Coding Specialist Certificate -
Contra Costa Medical Career College
Antioch, CAAssociates of Arts Degree in Paralegal Studies -
Heald College
Hayward, CAMedical Administrative Assistant Certificate -
Bryman College
San Francisco, CABachelor of Arts Degree in Legal Studies -
John F. Kennedy University
Pleasant Hill, CA01.2024
Hospital Billing and Coding - Certificate -
Pittsburg Adult Education Center
Pittsburg, CA01.2021
Timeline
Associate Claims Examiner
CEI Center: for Elders Independence
10.2021 - 09.2022
Medical Biller Externship
Allergy & Weight Loss/Endocrinology Center
07.2018 - 08.2018
Medical Biller in then Posting Department
BASS Medical Group
04.2018 - 11.2019
Medical Billing Follow-up Representative
BASS Medical Group
04.2018 - 11.2019
School Bus Driver / Student Monitor / School Bus Aid
Antioch School District
07.2013 - 04.2017
Operations Route Clerk / School Bus Driver
Durham/Peterman Transportation Services
09.2005 - 04.2010
Medical Administrative Asst. / Medical Biller / File Clerk
Kelly Temporary Services UCSF Campus
01.2004 - 01.2005
Medical Billing and Coding Cohort program -
San Francisco State University & Jewish Vocational Services (JVS)
Billing and Coding CPC Review program -
Martinez Adult Education Center
Medical Administrative/Billing & Coding Specialist Certificate -
Contra Costa Medical Career College
Associates of Arts Degree in Paralegal Studies -
Heald College
Medical Administrative Assistant Certificate -
Bryman College
Bachelor of Arts Degree in Legal Studies -
John F. Kennedy University
Hospital Billing and Coding - Certificate -
Pittsburg Adult Education Center
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