Hi, I’m
Shandee Robinson
Columbus,OH
Summary
Methodical Revenue Cycle Specialist with strong attention to detail and in-depth understanding of billing procedures. Excellent planning and problem-solving abilities. Prepared to bring 7+ years of related experience to a dynamic position with room for career growth.
Overview
8
years of professional experience
Work History
Trinity Health
Payment Resolution Analyst II
12.2019 - Current
Job overview
- Responsible for the reporting, monitoring, analysis, and follow-up of denials.
- Provides appropriate denial information to root cause areas to ensure systems, processes and measures of effectiveness
- Utilizes resources to accomplish objectives and meet deadlines. Demonstrates problem-solving skills related to denial analysis.
- Reports issues and trends to management personnel and works collaboratively to develop solutions.
- Follows documentation standards
- Prepares necessary documentation to submit appeals to payers when payment is delayed or denied. Rebills or reprints claims as necessary and appropriate.
- Assist with ongoing mentorship to colleagues and facilitate training programs for new hires.
Molina Healthcare
Contract Specialist
09.2022 - 03.2023
Job overview
- Negotiated optimal contract terms and conditions to lessen business risk and maximize financial objectives
- Closely monitored and evaluated contract performance to determine regulatory compliance and necessary amendments.
- Created and prepared specific contracts to present to senior management
- Conducted quality reviews and monitored contract performance
- Provided exceptional customer service to diverse clientele even in high-stress environments
- Reviewed contract plans and project specifics for a thorough understanding
- Managed full procurement cycle by planning, reviewing, soliciting, awarding, administering, and closing out contracts to achieve seamless transition at all levels of procurement
Sedgwick CMS Claims
Lead Claims Processor
05.2019 - 12.2019
Job overview
- Maintained strong knowledge of basic medical terminology to better understand services and procedures
- Tracked and reported on claims processing metrics to aid senior management in making informed decisions
- Reviewed applications and supporting documents to verify claims eligibility and accuracy
- Developed and implemented quality assurance processes to check accuracy of claims processing
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes
- Evaluated accuracy and quality of data entered into agency management system
- Managed workload and priorities to meet claims processing meet deadlines
- Checked documentation for accuracy and validity on updated systems
- Reviewed outstanding requests and redirected workloads to complete projects on time
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards
- Utilized specialized software to process incoming claims, enter data and generate reports
- Monitored claims processing trends to identify potential areas of improvement
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims
DERMATOLOGY & SKINCARE ASSOCIATES
Assistant Office Manager
09.2018 - 05.2019
Job overview
- Created and implemented organizational policies and procedures
- Hired, managed, developed, and trained staff; established and monitored goals; conducted performance reviews and administered salaries for staff
- Coordinated office events, seminars, and meetings for staff and clients
- Analyzed and solved multi-faceted problems that effected executive leaders and business initiatives
- Created an organized filing system to manage department documents
- Oversaw accounting, budgeting, and financial reporting
- Assessed processes and procedures, complying with OSHA and HIPAA regulations
- Assisted with regulatory issues such as compliance
- Identified opportunities to streamline processes and improve office operations and efficiency
- Developed close working relationships with the front office and back office staff
OHIO HEALTH
Medical and Administrative Assistant
03.2015 - 08.2018
Job overview
- Obtain patient demographic, insurance and medical information via computer, hardcopy and/or phone by using several methods including electronic medical records and hospital websites
- Office inventory/purchasing
- Data entry of patient demographic, insurance and medical information into computer system for insurance claims submission and patient billing
- Data entry of payments received from insurance companies and patients
- Contact insurance companies to ensure that pre-certification is obtained on procedures that require authorization
- Verifying insurance eligibility
- Follow-up on patient accounts
- Answer incoming phone calls in a timely and courteous manner, resolve callers’ inquiries
- Perform adjustments on accounts that require correction
- Ensuring payment of patient accounts, including light collections
- Rooming patient collecting vitals, drawing blood, administering injections, casting, dressing changes, assisting MD with any in office procedures, and accurately charting in EMR.
Education
WGU
Bachelor's from Digital Marketing
05.2024
Digital Marketing Blueprint
Certificate in Digital Marketing
12.2017
Tri RiversMarion, OH
Certificate from Clinical and Administrative Medical Assisting
05.2014
Skills
- Claims Review
- Revenue Cycle Management
- Medical Billing/Medical Coding
- Managing Records
- Best Practices and Standards
- Procedural Codes
- Insurance Collaboration
- CMS Guidelines
Timeline
Contract Specialist
Molina Healthcare
09.2022 - 03.2023
Payment Resolution Analyst II
Trinity Health
12.2019 - Current
Lead Claims Processor
Sedgwick CMS Claims
05.2019 - 12.2019
Assistant Office Manager
DERMATOLOGY & SKINCARE ASSOCIATES
09.2018 - 05.2019
Medical and Administrative Assistant
OHIO HEALTH
03.2015 - 08.2018
WGU
Bachelor's from Digital Marketing
Digital Marketing Blueprint
Certificate in Digital Marketing
Tri Rivers
Certificate from Clinical and Administrative Medical Assisting
Similar Profiles
Brook BerkhemerBrook Berkhemer
Multi- Skilled Technician at Trinity HealthMulti- Skilled Technician at Trinity Health
Stephanie BrionesStephanie Briones
Front Desk Receptionist at Trinity HealthFront Desk Receptionist at Trinity Health
Zaid AlmajaliZaid Almajali
Patient Care Assistant at Trinity HealthPatient Care Assistant at Trinity Health
Amy MoreauAmy Moreau
Cardiac Device Clinic Technician/Lead at Trinity HealthCardiac Device Clinic Technician/Lead at Trinity Health
Thomas WaglerThomas Wagler
Senior Quality Engineer at Abbott - NutritionSenior Quality Engineer at Abbott - Nutrition