Summary
Overview
Work History
Education
Skills
Timeline
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Shannon Casias

Lubbock

Summary

Dynamic Investigative Medical Auditor at Texas Mutual Insurance Company with expertise in ICD-10 proficiency and compliance monitoring. Proven track record in enhancing documentation practices and fostering collaboration among healthcare professionals. Recognized for exceptional attention to detail and effective communication, driving successful outcomes in audits and provider education initiatives.

Experienced with medical auditing, focusing on ensuring accurate and compliant patient records and billing. Utilizes analytical skills to identify discrepancies and improve processes. Knowledge of healthcare regulations and audit procedures, consistently delivering thorough and precise audit reports.

Overview

18
18
years of professional experience

Work History

Investigative Medical Auditor

Texas Mutual Insurance Company
05.2022 - Current
  • Fostered collaboration between clinical staff and administrative personnel to align documentation practices with organizational needs.
  • Provided support during external audits conducted by governmental agencies or third-party payers, ensuring timely completion and submission of required documentation.
  • Established strong working relationships with physicians and other healthcare professionals to facilitate open communication channels regarding best documentation practices.
  • Maintained an up-to-date understanding of evolving healthcare regulations by engaging in continuous professional development opportunities.
  • Completion of thorough audits and appeals
  • Conduct reviews that are complete and consistent with audit protocols and contain all SID special handling modifiers and language
  • Update and maintain SID tools & resources.
  • Prepare for and conduct on-site investigations as well as provider educations with health care providers and or billing representative(s).
  • Ensure compliance with applicable statutes, rules, and guidelines.
  • Ensure compliance with the Texas Workers' Compensation Act, DWC rules, and guidelines, ODG guidelines and fair and reasonable standards and departmental review guides
  • Protect sensitive information by complying with company and departmental procedures on the protection of sensitive information and follow appropriate notification procedures in the event of an unauthorized release of sensitive information.
  • Provide case support to Healthcare Fraud Investigators to optimize results.

Medical Audit Bill Reviewer

Texas Mutual Insurance Company
03.2012 - 05.2022
  • Maintained strong attention to detail while reviewing numerous documents daily, ensuring consistent quality and accuracy.
  • Maintained strict confidentiality with sensitive client information, adhering to industry standards and company policies.
  • Reduced turnaround time for reviews by effectively prioritizing tasks and managing deadlines.
  • Supported continuous improvement initiatives by actively participating in team meetings, trainings, and workshops focused on enhancing reviewer skills and processes.
  • Worked 14 different pend queues.

X-Ray Technician

Concentra Medical Centers
04.2007 - 03.2012
  • Completed x-rays safely by correctly using shielding equipment following OSHA requirements.
  • Increased patient safety by strictly adhering to radiation protection guidelines and using protective devices when necessary.
  • Maintained examination rooms and restocked medical and radiologic supplies.
  • Promoted patient satisfaction through compassionate care and effective communication during all stages of the imaging process.
  • Assisted in training new X-Ray technicians, sharing knowledge, tips, and best practices to improve overall department performance.
  • Optimized image quality with correct positioning techniques tailored to individual patients'' needs or conditions.
  • Maintained high-quality images by performing routine equipment maintenance and troubleshooting issues promptly.
  • Enhanced patient comfort by providing clear explanations of imaging procedures.
  • Ensured timely completion of exams by executing efficient workflows that balanced high-quality image acquisition with patient comfort.
  • Developed and processed radiologic film to aid in diagnostics and patient monitoring with high-quality imagery.
  • Assisted doctor during procedures, helping to run machinery and keep patients comfortable and still.
  • Collaborated with radiologists to ensure accurate diagnoses, discussing patient histories, and sharing observations.
  • Coordinated with other healthcare professionals to provide seamless multidisciplinary care for patients requiring additional tests or treatments after x-ray examinations.
  • Customized exam protocols based on physician orders or specific diagnostic requirements, maximizing efficiency without sacrificing quality results.
  • Positioned patients for optimal comfort and set up effective sterile fields before procedures.
  • Managed admissions forms, patient instructions and consent documentation.

Education

No Degree - Surgical Technology

South Plains College
Levelland, TX
08-2009

Skills

  • ICD-10 proficiency
  • Medical record review
  • HIPAA compliance
  • Clinical documentation
  • Healthcare regulations
  • Compliance monitoring
  • Spreadsheet skills
  • Medical billing
  • Medical coding
  • Medicare guidelines
  • Teamwork and collaboration
  • Teamwork
  • Customer service
  • Problem-solving
  • Time management
  • Attention to detail
  • Problem-solving abilities
  • Multitasking
  • Multitasking Abilities
  • Excellent communication
  • Critical thinking
  • Clear communication
  • Organizational skills
  • Team collaboration

Timeline

Investigative Medical Auditor

Texas Mutual Insurance Company
05.2022 - Current

Medical Audit Bill Reviewer

Texas Mutual Insurance Company
03.2012 - 05.2022

X-Ray Technician

Concentra Medical Centers
04.2007 - 03.2012

No Degree - Surgical Technology

South Plains College

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