Summary
Overview
Work History
Education
Skills
Timeline
Generic

Shannon De La Fuente

Fresno,CA

Summary

Obtain a position where utilize current knowledge, in Medical Billing/Coding to benefit the company, and to adapt to all new challenges offered. Authorized to work in the US for any employer Competent Accounts Receivable Specialist bringing 21 years of experience carrying out all accounts receivable functions in high volume environments. Proficient in tracking payments, resolving billing issues and preparing account statements. Recognized as dedicated professional driven to meet team targets and enhance bottom-line performance.

Overview

21
21
years of professional experience

Work History

Senior Accounts Receivable Representative

United Healthcare Group
11.2021 - Current
  • Working knowledge of medical terminology and related procedure and diagnostic coding
  • Knowledge of how to access available resource tools
  • Knowledge in medical insurance Explanation of Benefits
  • Operate general office equipment, including personal computer, telephone, photocopy machine, fax machine.
  • Proficient in basic math skills including percentages
  • Process claim data of all claims types comprehensively, accurately, and efficiently
  • Process quota of 50 plus medical claim denials
  • Appropriate claims follow-up
  • Utilize Epic EMR
  • Followed up overdue payments and payment plans from clients to establish good cash flow.
  • Monitored accounts to verify compliance with payment terms and schedules.
  • Identified, researched, and resolved billing variances to maintain system accuracy and currency.
  • Handled day-to-day accounting processes to drive financial accuracy.
  • Reconciled accounts, managed audits and updated financial records with remarkable accuracy.

Insurance Representative II

PFS Group
01.2021 - 11.2021
  • Communicated with insurance providers to resolve denied claims and resubmitted
  • Located errors and promptly refiled rejected claims
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers
  • Precisely completed appropriate claims paperwork, documentation and system entry
  • Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts

AR Representative

Central California Ear and Nose Throat
04.2018 - 11.2020
  • Strong knowledge in, electronic and hard copy billing of insurance, Medicare, Managed Care & Medi-Cal
  • Knowledge in authorizations request, adjustments, posting checks, requesting refunds, denials, and data entries
  • Working knowledge of medical terminology and related procedure and diagnostic coding
  • Knowledge of how to bill second and third party insurance company's
  • Knowledge in medical insurance Explanation of Benefits
  • Operate general office equipment, including personal computer, telephone, photocopy machine, fax machine, etc
  • Proficient in basic math skills including percentages
  • Perform extensive work in professional manner
  • Process claim data of all claims types comprehensively, accurately and efficiently
  • Processed 45 or more patient accounts
  • Good working relations with payers'
  • Able to perform follow-ups on outstanding accounts, and current accounts daily
  • Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.
  • Gathered, organized and input information into digital database.
  • Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
  • Greeted customers warmly to set tone of customer experience and provide welcoming and friendly atmosphere.

Billing Specialist

California Cancer Associates
01.2015 - 02.2018
  • Electronic and hard copy billing of Insurance, Medicare, Managed Care & Medi-Cal
  • Authorizations, adjustments, posting checks, requesting refunds, denials, data entry
  • Working knowledge of medical terminology and related procedure and diagnostic coding
  • Knowledge of how to access available resource tools
  • Knowledge in medical insurance Explanation of Benefits
  • Operate general office equipment, including personal computer, telephone, photocopy machine, fax machine.
  • Proficient in basic math skills including percentages
  • Process claim data of all claims types comprehensively, accurately and efficiently.
  • Verified accuracy of accounts payable payments, resulting in 50% reduction in payment errors and check reissues
  • Researched and resolved billing discrepancies to enable accurate billing.
  • Assisted with billing inquiries and provided timely responses to enhance customer satisfaction.

Medical Billing Specialist

Scott & White
01.2014 - 08.2014
  • Communicated with insurance providers to resolve denied claims and resubmitted
  • Located errors and promptly refiled rejected claims
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy
  • Posted and adjusted payments from insurance companies
  • Communicated effectively and extensively with other departments to resolve claims issues
  • Prepared billing correspondence and maintained database to organize billing information

Medical Biller

Mercy Medical Center
11.2002 - 05.2013
  • Handled day-to-day accounting processes to drive financial accuracy
  • Followed up overdue payments and payment plans from clients to establish good cash flow
  • Reconciled accounts receivable ledger to verify payments and resolve variances
  • Utilized Microsoft Excel, software to manage invoices and payments
  • Generated invoices upon receipt of billing information and tracked collection progress
  • Reconciled accounts, managed audits and updated financial records with remarkable accuracy
  • Verified accuracy of accounts payable payments, resulting in 50% reduction in payment errors and check reissues

Education

Associates - Business Technology, Medical Billing & Coding

Fresno City College
Fresno, CA
05.2022

Skills

  • Medical Terminology
  • Managed Care
  • EMR Systems
  • Medical Coding
  • Epic
  • Anatomy Knowledge
  • Accounting
  • Quality Assurance
  • Behavioral health
  • Month-End Closing Procedures
  • Understanding procedures and forms used for medical billing
  • Billing Dispute Resolution
  • Correspondence Writing
  • Financial Efficiency

Timeline

Senior Accounts Receivable Representative

United Healthcare Group
11.2021 - Current

Insurance Representative II

PFS Group
01.2021 - 11.2021

AR Representative

Central California Ear and Nose Throat
04.2018 - 11.2020

Billing Specialist

California Cancer Associates
01.2015 - 02.2018

Medical Billing Specialist

Scott & White
01.2014 - 08.2014

Medical Biller

Mercy Medical Center
11.2002 - 05.2013

Associates - Business Technology, Medical Billing & Coding

Fresno City College

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Shannon De La Fuente