SHANNAH FOX
Menomonee Falls,WI
Summary
Experienced Reimbursement Specialist with exemplary analyzation abilities managing claims and preventing payment issues. Dedicated to ensuring clients receive due compensation for dental and vision insurance claims. Confident and competent with a well-established knowledge of the general industry.
Overview
19
19
years of professional experience
Work History
Reimbursement Analyst
SKYGEN USA
09.2018 - Current
- Submit accurate and timely payments to providers, keeping within contractual SLA’s for each market
- Understand and interpret benefit limitations by having a comprehensive understanding of benefits and State requirements for multiple markets
- Assure that claims are paid within the expected time frames by monitoring inventory control and working with team members and appropriate resources in other areas to resolve issues
- Identify trends and make appropriate suggestions to procedures to improve efficiencies
- Resolve complex claim payment inquiries by analyzing patient activity and related documentation (including enrollment, claims, and authorizations) and determine appropriate action
- Resolve complex client issues that may require research, analysis and working with management
- Complete requests for claims review and/or reprocess within internal guideline turnaround times
- Provide necessary feedback and communications as needed to clients
- Provide training and guidance to team members on market specific issues
- Updatine check run procedures as needed
- Improve reimbursement processes by analyzing and resolving payment discrepancies.
- Assist with upgrade testing
EDI Analyst
SKYGEN USA
04.2017 - 09.2018
- Monitored EDI file processing, track requests and assist in resolving production issues
- Verified inbound and outbound dental 837D files for accuracy and data integrity
- Analyzed dental 837D EDI files for accuracy
- Tracked and recorded EDI file submissions
- Prepared summary reports for clients
- Utilized companion guides to determine configuration changes required
- Coordinated with clients to resolve issues and improve processes with their data interchange needs
- Ensured compliance with industry standards, researching updates to the ANSI X12 format as needed.
- Evaluated current practices regularly to identify opportunities for improvement in coordination with IT teams or vendors.
- Contributed to the development of training materials for employees transitioning into roles that required familiarity with EDI concepts or responsibilities.
Account Compliance Specialist
Dental Associates
09.2012 - 12.2017
- Analyzed discrepancies on accounts and make necessary corrections
- Reviewed credits and balances on accounts to apply payments or initiate refunds
- Completed adjustments for redo/remakes and lab errors
- Applied coupons, vouchers, and discounts to patient accounts
- Recorded daily deposits made and closed payment, adjustment and charges batches daily
- Mentored and train new employees
- Assisted in the preparation of regular reports for senior management, detailing compliance activities and progress towards established goals.
- Reduced instances of non-compliance through meticulous monitoring of internal controls and periodic audits.
Major Work Specialist
Dental Associates
03.2012 - 12.2017
- Submitted electronic pre-authorizations and claims for dental procedures
- Reviewed progress notes and x-rays to determine in-house insurance benefits
- Assigned appropriate ICD-10 and CPT codes for surgical procedures
- Assisted in updating approval guidelines for major work processes
- Interpreted and entered EOB's into patient accounts for accurate insurance estimates
- Reviewed patient accounts and treatment plans for billing accuracy
- Applied VA grants -Handle inquiries from other departments regarding insurance estimates and claim discrepancies
- Followed all company policies and procedures to deliver quality work.
Dental Assistant
Dental Associates
04.2005 - 03.2012
- Certified Dental Assistant 2008-2012
- Successfully assisted dentist by performing four-handed dentistry and other chair-side duties.
- Documented patient dental health information, medical history, and vital signs for future reference
- Specialized in oral diagnosis and endodontics
- Took digital x-rays including panoramic, periapical and bitewing x-rays
- Scheduled patient appointments
- Cleaned and sanitized dental tools and equipment, straightened treatment rooms, and restocked supplies to prep for next patient and maintain health and safety practice
- Explained treatment procedures and instructed patients on home care guidelines.
Education
Business Systems Analyst Certificate -
WCTC
Pewaukee, WI12.2024
Human Resource Management, A.A.S -
WCTC
Pewaukee, WI01.2014
Compensation and Benefits Specialist Certificate -
WCTC
Pewaukee, WI01.2013
Medical Coding Certificate -
MATC
Milwaukee, WI01.2012
Skills
- Microsoft Excel
- Microsoft Access
- Microsoft SQL Server
- Microsoft Teams
- Microsoft Powerpoint
- Analytical Thinking
- Type 50 wpm
- Claims Processing
- HIPAA Compliance
- Healthcare Reimbursement
- Medicaid knowledge
Timeline
Reimbursement Analyst
SKYGEN USA
09.2018 - Current
EDI Analyst
SKYGEN USA
04.2017 - 09.2018
Account Compliance Specialist
Dental Associates
09.2012 - 12.2017
Major Work Specialist
Dental Associates
03.2012 - 12.2017
Dental Assistant
Dental Associates
04.2005 - 03.2012
Business Systems Analyst Certificate -
WCTC
Human Resource Management, A.A.S -
WCTC
Compensation and Benefits Specialist Certificate -
WCTC
Medical Coding Certificate -
MATC
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