Shannell Rhodes
Nashville,TN
Summary
Detail-oriented Revenue Cycle professional with 18+ years of experience in healthcare administration, medical billing, and claims adjudication. Expertise in Accounts Receivable Follow-up, Denial Management, and the end-to-end Claims Submission process to maximize reimbursement. Proven ability to utilize Payer Portals and Microsoft Office tools to resolve complex insurance discrepancies while ensuring 100% HIPAA compliance.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Medical Assistant/Billing/Coding Specialist
VANDERBILT UNIVERSITY
NASHVILLE, TN
07.2022 - Current
- Optimize Revenue Cycle Management (RCM) by accurately identifying and resolving coding errors before claims submission, reducing initial denial rates by approximately 15%.
- Utilize Epic EHR and Microsoft Office to track patient billing cycles and ensure timely accounts receivable follow-up for all clinical services.
- Identify administrative friction in the eligibility verification process and implement updated workflows to minimize coordination of benefits (COB) denials.
- Maintain strict HIPAA standards while managing sensitive patient data and electronic health records to ensure secure data entry and information transfer.
Quality Assurance Analyst
DCI DONOR SERVICES, INC
NASHVILLE, TN
02.2021 - 05.2022
- Perform comprehensive medical chart review to ensure all documentation supports billing requirements and meets internal quality standards.
- Identify data entry inconsistencies in patient files, escalating high-risk errors to leadership to prevent revenue leakage from potential audit failures.
- Utilize analytical methodologies to assess the accuracy of healthcare records and improve overall data integrity for reporting purposes.
- Escalate non-compliance issues discovered during chart audits to ensure prompt resolution and adherence to federal healthcare regulations.
Medical Assistant
NEIGHBORHOOD HEALTH
NASHVILLE, TN
04.2019 - 02.2021
- Resolve patient insurance eligibility issues at the point of care, significantly decreasing front-end denials and streamlining the patient intake process.
- Utilize Healthcare Customer Service techniques to explain billing procedures and insurance requirements to patients, enhancing the overall patient experience.
- Assisted medical providers with clinical services while maintaining accurate data entry of procedure codes and diagnosis codes into the EHR.
- Managed scheduling for a diverse patient population, ensuring optimal clinic throughput and efficient provider credentialing validation.
Medical Assistant
VANDERBILT MEDICAL CENTER
NASHVILLE, TN
08.2018 - 04.2019
- Execute professional insurance billing and coding tasks, ensuring that all routine outpatient activities were documented for accurate claims submission.
- Identify and resolve discrepancies in patient insurance coverage during front-desk phone triage, preventing unpaid claims at the source.
- Utilize e-clinical systems for efficient data entry of patient charting, medications, and laboratory orders while adhering to HIPAA guidelines.
- Manage the accounts receivable lifecycle by collecting patient co-pays and ensuring accurate check-in/check-out billing procedures.
CTM Coordinator/Claims Analyst
CVSCAREMAKE
NASHVILLE, TN
11.2015 - 06.2018
- Resubmit insurance claims after conducting deep-dive research into payment discrepancies and historical claim data for Medicare D prescriptions.
- Perform advanced Denial Management by analyzing Medicare Part D complaints and identifying systemic issues causing underpaid or rejected claims.
- Utilize Payer Portals and internal analytical tools to resolve outstanding accounts receivable, ensuring accurate reimbursement for all prescription services.
- Provide high-level Healthcare Customer Service by resolving complex billing complaints and providing clear explanations of Medicare Part D benefits.
Medicare B Claims Processor
CIGNA GOVERNMENT SERVICES
MADISON, TN
04.2007 - 04.2010
- Examine and process paper and electronic claims for Medicare Part B, ensuring 100% accuracy in data entry and adjudication workflows.
- Determine the appropriate action to return, pend, deny, or pay claims based on rigorous application of Medicare policies and insurance regulations.
- Identify root causes of claim errors and collaborate with internal teams to minimize revenue leakage through improved processing accuracy.
- Utilize specialized payer portals and database tools to track claim status and maintain a zero-backlog standard in high-volume environments.
Medical Assistant/Phlebotomist
Rama Medical
Nashville, TN
05.2005 - 03.2007
- Assisted in patient intake, ensuring accurate information collection and record maintenance.
- Supported healthcare providers with clinical tasks, enhancing workflow efficiency and patient care quality.
- Coordinated appointments and managed scheduling to optimize provider time and reduce patient wait times.
- Educated patients on treatment plans, medications, and follow-up procedures to improve adherence and outcomes.
- Conducted routine diagnostic tests and recorded results, contributing to accurate assessments and treatment decisions.
Education
Associate's degree - Medical Billing & Coding
MEDCERT
10.2023
Diploma - Medical Assistant
REMINGTON COLLEGE - NASHVILLE CAMPUS
NASHVILLE, TNHigh school diploma - undefined
ANTIOCH HIGH SCHOOL
ANTIOCH, TN05.1999
Skills
- Revenue Cycle & Billing: Accounts Receivable Follow-up, Claims Adjudication, Claims Submission, CPT Coding, Denial Management, ICD-10 Coding, Medical Billing, Medicare Part B & D, Revenue Cycle Management, medical claims Electronic Data Interchange (EDI)
- Technical Tools: Data Entry, e-Clinical Systems, Epic EHR, Excel, Microsoft Office, Payer Portals
- Compliance & Operations: Healthcare Customer Service, HIPAA, Insurance Eligibility Verification, Medical Chart Review, Provider Credentialing
Certification
- Medical Coding Certification - Medcert (October 2023)
- Epic Certification - Epic Systems (July 2022)
- RMA Certified Medical Assistant - AMT (July 2011)
Languages
English
Timeline
Medical Assistant/Billing/Coding Specialist
VANDERBILT UNIVERSITY
07.2022 - Current
Quality Assurance Analyst
DCI DONOR SERVICES, INC
02.2021 - 05.2022
Medical Assistant
NEIGHBORHOOD HEALTH
04.2019 - 02.2021
Medical Assistant
VANDERBILT MEDICAL CENTER
08.2018 - 04.2019
CTM Coordinator/Claims Analyst
CVSCAREMAKE
11.2015 - 06.2018
Medicare B Claims Processor
CIGNA GOVERNMENT SERVICES
04.2007 - 04.2010
Medical Assistant/Phlebotomist
Rama Medical
05.2005 - 03.2007
Diploma - Medical Assistant
REMINGTON COLLEGE - NASHVILLE CAMPUS
High school diploma - undefined
ANTIOCH HIGH SCHOOL
Associate's degree - Medical Billing & Coding
MEDCERT