Shandiin Isaac
Dallas,TX
Summary
Experienced Claims Auditor with background in scrutinizing insurance claims for compliance and identifying discrepancies. Strengths include comprehensive understanding of auditing procedures, sharp analytical skills, and ability to interpret complex insurance documents accurately. Proven history of enhancing efficiency by improving audit processes and documenting findings effectively.
Overview
16
16
years of professional experience
Work History
Medical Claims Auditor I
Gainwell Technology
Irving, TX
05.2021 - 02.2024
- Collaborate with team members, management and clients to resolve client inquiries; cross-train new resources in customer service processes and payment posting processes
- Confirm and validate third party liability, probate, and beneficiary asset check research
- Assist with Lockbox trouble shooting and questions with payer, client, and Bank
- Post a high volume of payments and adjustments accurately from payor remittances to patient accounts
- Balance payment batches
- Performed focused payer reports to identify and correct payer variances and report to management.
Medical Billing Specialist III/Strategic Operation Specialist
PHI Air Medical L.L.C.
Phoenix, AZ
10.2007 - 06.2015
- Exceptional Ability to prioritize work to meet goals and objectives within acceptable time frames
- Perform QA Control on completed HCFA 1500 claims, and responded to provider special request
- Provided/Assisted training with New Hires and Existing employees with additional training needs
- Provide Closest Appropriate Facility review and researching current Level 1 trauma Centers
- Provide accurate review of all accounts submitted for agency transfer and write-offs
- Liaison for collection agencies and attorneys
- Assist with Month End Reporting
- Performed and maintained consistence customer focused in the face of adversity and change
- Performed Data Entry, follow up via telephone eligibility of benefits, claims status and corrections application document control
- Displacement competence and communication both verbal and written interpersonal relations, as time in sensitive stressful situations
- Handled all aspects of billing including paper claims and performed some collections depending on client
- Gathered and Inputted patient information into Citrix system and Golden Hour Live V-6.
TEAM OPERATION COORDINATOR/TEAM LEAD
PHI Air Medical L.L.C.
Phoenix, AZ
06.2015
- Provide training for New Hires/existing employees with additional training needs
- Performed focused payer and program audits to identify and correct payer variances
- Provide oversight of any payer that is managed outside of existing systems and workflows
- Assist with Month End Reporting
- Assist with Lockbox trouble shooting and questions with payer, client, and Bank
- Provide account review of all accounts submitted for agency transfer and write-offs
- Participated in development of organization procedures and update of forms and manuals
- Ensure Strict confidentiality of financial records
- Respond to questions and offer solutions to resolve patient accounts and work with the caller to provide a thorough and complete understanding about the billing process co-payments, coinsurance and deductibles Non-Covered charges explanation of benefits and Personal Health Statements to the subscriber.
Education
Health Management -
DeVry University
07.2010
High School Diploma -
05.1998
Certificate -
United Education Institute
Skills
- Medical Terminology
- Medical Legal and Ethics
- Good Filing and organizational skills
- Detailed Oriented
- Microsoft Outlook
- Excel
- Word
- Internet
- 10-Key
- Power Point
- Positive Attitude
- Dependable
- Strong sense of responsibility
- Flexible
- Ability to effectively prioritize and handle multiple tasks
- Work under aggressive time constraints
- Overpayment identification
- Insurance knowledge
- Exemplary communication skills
- Claims Processing
- Data Analytics
- Compliance and regulations
- Team Collaboration
Timeline
Medical Claims Auditor I
Gainwell Technology
05.2021 - 02.2024
TEAM OPERATION COORDINATOR/TEAM LEAD
PHI Air Medical L.L.C.
06.2015
Medical Billing Specialist III/Strategic Operation Specialist
PHI Air Medical L.L.C.
10.2007 - 06.2015
Health Management -
DeVry University
High School Diploma -
Certificate -
United Education Institute
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