Shannon Davies
Medical Biller & Reimbursement Specialist
Crystal Lake,IL
Summary
Detail-oriented professional with focus on deadlines and skilled in handling medical billing without errors. Confident Medical Biller knowledgeable in data confidentiality and privacy practices when reviewing patient information.
Overview
17
17
years of professional experience
Work History
Personal Support Worker
George Stringham/ Andrew Pudlo
11.2022 - Current
- Assisted client with daily living needs to maintain self-esteem and general wellness.
- Assisted client with daily living activities, promoting independence and wellbeing.
- Collaborated with healthcare professionals to develop customized care plans for individual patients.
- Built strong relationships with client to deliver emotional support and companionship.
Medical Biller (Remote)
CCRM Infertility
07.2023 - 04.2024
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
Biller/ Insurance Follow- Up Rep I & II (Remote)
Advocate Aurora Health
02.2022 - 11.2022
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Filed and updated patient information and medical records.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Verified insurance of patients to determine eligibility.
- No Surprises Act Subject process implementation of out of network denials under the No Surprise Act.
- Initiated open negotiations under the No Surprise Act with Non- contracted payers.
- Referred open negotiations cases that exceeded response deadline to internal departments initiate review case to initiate Independent Dispute Resoluations
Medical Biller, Reimbursement Specialist, Referral
Northwest Oncology & Hematology
01.2018 - 02.2022
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Verified insurance of patients to determine eligibility.
- Improved patient satisfaction levels with clear explanations of their financial responsibilities and available payment options.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Filed and updated patient information and medical records.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Posted payments and collections on regular basis.
Medical Biller and Insurance Verification
GERMBUSTERS INFECTIOUS DISEASES OF ADULTS & CHILDR
04.2014 - 01.2018
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Verified insurance of patients to determine eligibility.
- Improved patient satisfaction levels with clear explanations of their financial responsibilities and available payment options.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Filed and updated patient information and medical records.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Posted payments and collections on regular basis.
Medical Records Client Service Representative
IOD Incorporated
12.2007 - 07.2013
- Facilitated smooth transitions for patients transferring between facilities, coordinating the release of their medical records following all legal requirements.
- Maintained patient records in compliance with security regulations.
- Processed medical records requests from outside providers according to facility, state, and federal law.
- Uploaded physician progress notes, history, and physicals into electronic medical records.
- Reviewed charts and flagged incomplete or inaccurate information.
- Maintained patient confidence by keeping patient records information confidential.
- Printed and photocopied documents to provide patients with copies of medical records.
Skills
M
Claims review
Billing and Collection Procedures
Clerical Support
Commercial and Private Insurance
HIPAA Compliance Certification
Records Management
Teamwork and Collaboration
Multitasking and Organization
HIPAA compliance awareness
Claims Processing Proficiency
Payment Posting Abilities
Medical Terminology Mastery
ICD-10 Knowledge
CPT coding knowledge
ICD-10 Proficiency
Patient Confidentiality Maintenance
Accounts receivable management
Denial Management
Patient confidentiality
Claims Processing
Medical billing experience
Additional Information
AFFILIATED EAR, NOSE, THROAT PHYSICIANS - Woodstock, IL 03/2006 – 04/2007
Receptionist/Front Office Supervisor
UROLOGY) – Chicago, IL 03/2003 – 06/2005
Receptionist/Medical Secretary/Patient Care Coordinator
Timeline
Medical Biller (Remote)
CCRM Infertility
07.2023 - 04.2024
Personal Support Worker
George Stringham/ Andrew Pudlo
11.2022 - Current
Biller/ Insurance Follow- Up Rep I & II (Remote)
Advocate Aurora Health
02.2022 - 11.2022
Medical Biller, Reimbursement Specialist, Referral
Northwest Oncology & Hematology
01.2018 - 02.2022
Medical Biller and Insurance Verification
GERMBUSTERS INFECTIOUS DISEASES OF ADULTS & CHILDR
04.2014 - 01.2018
Medical Records Client Service Representative
IOD Incorporated
12.2007 - 07.2013