Shan Lee

Work History

Medix / Orlando Health

03.2023 - Current

Streamlined front-end billing edits to ensure accuracy and compliance with payer requirements, reducing claim rejections and increasing reimbursement efficiency
Reviews and resolved claim denials that are related to the credentialing and enrollment status of all OH employed providers.
Developed and delivered comprehensive operational reports using Epic, achieving 99% accuracy in reporting to stakeholders
Spearheaded process improvements, reducing insurance denials through enhanced data analysis and KPI tracking
Collaborated with Account Management teams to resolve claim issues within targeted timeframes, ensuring 100% compliance with resolution timelines
Analyzed in-depth financial analysis to identify revenue cycle inefficiencies, increasing cash collections
Created billing processes through automation of manual tasks, improving operational efficiency
Developed and managed analytics projects, driving key insights for senior leadership and improving decision-making through advanced Epic reporting techniques
Expertise in ICD-10, CPT, HCPCS, and Local Coverage Determination (LCD) regulations to ensure compliance and accuracy in claims processing
Delivered achievable quality audits on-time for project delivery while managing multiple high-priority initiatives simultaneously
Engage in Leadership/Supervisor meetings providing constructive feedback for process improvement and recommendations to promote teamwork.

AdventHealth

02.2021 - 01.2024

Lead a team of 12 HIM professionals, increasing productivity through effective resource allocation and staff development
Monitored and reduced document imaging turnaround times for inpatient and outpatient batches, achieving an average processing time of 0.4 days
Achieved a 98% quality control rating by implementing random monthly audits and providing real-time feedback to team members
Streamlined record completion processes, enabling coding delays and improving reimbursement outcomes by optimizing workflows
Played a critical role in the implementation of OnBase, ensuring full compliance with AdventHealth policies, CMS guidelines, and federal/state regulations
Managed cross-functional coordination between PA/PFS management, managed care, vendors, and hospital staff, significantly improving workflow timeliness
Created comprehensive training programs, resulting in a reduction in employee onboarding time and improved overall team performance
Audits and review team’s productivity performance to provide feedback as needed to meet goals and deadlines efficiently
Managed daily operations for optimal performance, ensuring smooth workflows and timely completion of tasks.

AdventHealth

12.2019 - 02.2021

Handled over 60+ insurance denial queues daily, resolving complex claims issues with 95% accuracy and reducing aged claims
Coordinated with United Healthcare to ensure accurate billing processes for assigned patient accounts, maintaining a 98% clean claim rate
Implemented root cause analysis techniques, leading to a reduction in recurring claim denials and increased revenue recovery
Regularly collaborated with the Account Manager to address and overcome billing challenges, enhancing revenue cycle performance
Processed reinstatements and rejections of insurance claims efficiently, ensuring timely reimbursement for medical services
Responsible for identifying payment variances for professional fee commerical contracts and government payers.
Identifying true variances(under/overpayments) based on reimbursement guidelines from past billing/payer experience, payer websites and contracted fee schedules.

EEP Billing OT, PT, ST Therapy

10.2018 - 12.2019

Managed insurance claim denials, achieving a reduction in denied claims through improved communication and claims submission processes
Proactively analyzed aged accounts, re-filing claims and retrieving necessary medical documentation to maximize revenue collection
Created and executed strategic action plans to address denial root causes, resulting in an improvement in claim approvals
Tracked and processed denial reports with 99% accuracy, ensuring compliance with payer guidelines and minimizing financial losses

Orlando Health

01.2011 - 08.2018

Worked on insurance denial reports, resolving claim issues with 95% accuracy and ensuring timely reimbursement for assigned patient accounts
Re-filed insurance claims as needed, reducing accounts receivable backlog within 6 months
Analyzed aging reports and collaborated with billing teams to resolve discrepancies, driving increased revenue collection and minimizing outstanding balances

Dermatology Billing

07.2006 - 12.2010

Managed accounts receivables for 36 practices, overseeing over 60 doctors and leading a team of 19+ employees
Reduced outstanding AR through diligent monitoring and auditing of claims, ensuring timely collections with special projects assigned by the reimbursement manager with in a time frame
Ensured compliance with Medicare, Medicaid, and private payer policies, reducing claim rejection rates
Trained and mentored staff in coding, collections, and payer regulations, achieving consistent top performance within the department
Responsible for day to day operations of Quality Audit, Training and Education team. Written and verbal directions were provided to the team as a requirement.