Summary
Overview
Work History
Education
Skills
Timeline
Generic

Shanel Riales

Mobile,Alabama

Summary

I am self-motivated, detail-oriented, and results-driven with over 12 years of hands-on experience in account management, revenue generation, and medical billing. I have the ability to manage multiple projects and tasks, strong planning and time management abilities, and the skills to develop strategies to improve workflows and processes. I am meticulous and offer comprehensive experience. I am a driven partner eager for professional growth with increased responsibility and looking to improve department productivity through effective process improvements. I have the ability to work with individuals from varying backgrounds, demonstrate leadership skills, and work independently or as part of a supportive team.

Overview

12
12
years of professional experience

Work History

Billing Training Coordinator

Infirmary Health Systems
08.2019 - Current
  • Started as a Medicare Billing Specialist, ensuring daily submission of claims with zero errors
  • Reviewed claims for coding accuracy and maintained high accuracy rate
  • Collaborated with other departments to resolve claim issues.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Maintained high accuracy rate on daily production of completed reviews.
  • Completed appeals, filed, and submitted claims.
  • Transitioned to the Medicare Coordinator role, working on aged as well as high dollar accounts. I handled the billing, denials, and follow-up of Clinical Trials/IV Infusion accounts. These account types are complex and high dollar.
  • I was the first line of communication for billers. I took the initiative to create tip sheets to provide detailed and payer specific training.
  • I collaborated with the team leader in addition to the manager on processes to ensure guidelines were met in addition to creating ways to improve productivity.
  • I became the department's training coordinator, conducting training sessions, providing support, and completing productivity and quality audits.
  • Provide training to billing department staff and create Tip Sheets for the team.
  • Maintaine accurate records of employee participation in training events, tracking progress towards learning objectives.
  • Coordinated with department leaders to identify training needs and develop targeted solutions.

Implementation Specialist III

CPSI/TruBridge
09.2012 - 08.2019
  • Started as a customer service agent in Insurance Follow Up. I called insurance companies to gather information on the status of hospital insurance claims.
  • Within 3 then promoted to the Private Pay Call Center.
  • After a month in the call center I because a supervisor where I managed a team four to ten agents.
  • I completed weekly performance goals, Quality Assurance on calls, weekly meetings with agents and issued training forms as necessary for errors.
  • . In addition to working with the team, I also managed 41 facilities.
  • I was promoted to Customer Relationship Management Administrative Assistant, responsible for running reports, updating spreadsheets, and assisting with escalated issues
  • When the department was phased out, I became the Revenue Cycle Management Administrative Assistant, providing administrative support and running reports.
  • I was responsible for running pertinent reports for assistant managers and manager to report monthly revenue of each hospital. These reports provide weekly and monthly revenue analysis, which offer suggestions for improving cash flow, and assisting with all escalated TruBridge issues.
  • I transitioned to a Medicare Billing Specialist
  • I would work billing Medicare Edits. Spool and work commercial claims for secondary. Update Medicare totals and work claim issues in the DDE. Maintain audits and status reports for all financial classes.
  • Communicate daily with facility coordinator.
  • Work on special projects as needed.
  • Communicate any requested information to management staff via email daily, weekly, and/or monthly.
  • Complete all tasks on daily checklist.
  • Maintain good working relationships with other ARMS division employees.
  • Excellent communication skills at all levels, from TruBridge staff to hospital staff.
  • I was promoted to Implementation Specialist III, facilitating training for clients and coordinating implementations.
  • Actively working with 97 different facilities all at different stages of their implementations. Managing multiple implementation projects concurrently, maintaining strict deadlines without compromising quality or scope.
  • Developed strong relationships with clients, fostering trust and confidence in the implementation process.
  • Delivered exceptionally high level of professionalism and support to each client, upholding company's commitment to service.
  • Maintained up-to-date knowledge of industry trends and best practices in order to provide the most relevant solutions for clients'' businesses.
  • Contributed to the continuous improvement of implementation processes through regular feedback sessions and lessons learned discussions.
  • Time management skills, Customer Relations, and Organizational Skills were a very large part of the implementation process.

Education

No Degree - Emergency Medical Technology

Bishop State Community College
Mobile, AL
12.2006

High School Diploma -

Woodruff High School
Peoria, IL
05.1997

Skills

  • Facilitation in training clients/employees
  • Medical billing & coding
  • Excellent organizational and time management skills
  • Excellent verbal and written communication skills
  • Highly motivated, reliable, confident, and committed to professional standards
  • Flexibility to handle a workload that fluctuates and grows with time
  • Working knowledge of EPIC, Payment Manager, and Medicare Direct Data Entry software
  • Strong data analytical skills
  • Ability to collect and analyze data, define problems, and troubleshoot solutions
  • Computer Proficiency
  • Working knowledge of Microsoft excel and word
  • Ability to work independently as a team member in a fast-paced environment while managing multiple priorities
  • Effective interpersonal and management skills

Timeline

Billing Training Coordinator

Infirmary Health Systems
08.2019 - Current

Implementation Specialist III

CPSI/TruBridge
09.2012 - 08.2019

No Degree - Emergency Medical Technology

Bishop State Community College

High School Diploma -

Woodruff High School

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Shanel Riales