Shannon Phillips Howard
Humana
Morehead
1
Certification
12
years of professional experience
Highly skilled and knowledgeable professional with experience in revenue cycle management, medical coding, denials, appeals, grievances and prior authorizations. Proven ability to analyze clinical documentation, interpret insurance contracts, and resolve complex billing and coding issues. Demonstrated strong analytical abilities and effective communication skills to facilitate smooth operations and client satisfaction.
Work History
Grievances and Appeals Representative IV
8 Months- Work from home position
- Advanced case management for grievances, appeals, and medical coverage denials for Medicare Advantage plans.
- Process highly complex or high-priority Level 2 member and provider appeals, and medical coverage denials.
- Investigate and resolve complex or urgent Level 2 member and provider escalations.
- Retrieve, validate, and analyze clinical documentation and prior authorizations to support appeal and case resolution.
- Coordinate with internal medical directors, utilization management, and clinical teams for submission to independent external review entities.
- Documented case activity accurately within claims and appeals systems.
- Maintained high productivity and quality standards in a production driven environment.
Lead Managed Care Analyst
4 Years 9 Months- Work from home position,
- Analyzed revenue cycle data to identify claim variances, denial trends, and process gaps.
- Resolve coding claim edits by researching billing holds, clearinghouse rejections, and system edits (such as NCCI bundling edits) to correct coding and charge errors.
- Experience working with ICD-10, CPT, HCPCS and revenue coding guidelines and conventions.
- Analyzed trends utilization AI platform, developed strategies, and mentored team members to optimize revenue recovery and improve processes.
- Submit professional inquires utilizing online forums such as Availity, eRM, Aetna, United Healthcare, UMR, Cigna and Humana websites.
- Reviewed insurance contracts to interpret information about payment methodology
- Proficient in programs such as Epic, Meditech, Cerner, Newman, Excel, Microsoft Word, Power Point and Outlook.
Coding Account Resolution Specialist
4 Years 5 Months- Work from home position.
- Researched edits and/or denials related to HCPCS, CPT, ICD-10 codes, billing or documentation discrepancies.
- Identified patterns or trends and escalated to management,
- Investigated problematic accounts by accessing the electronic record, billing system, coding guidelines and online resources.
- Utilized Epic, Meditech, McKesson, Encompass 360, eRequest, Outlook, and Abstract Manager.
- Adhered to all applicable coding and billing regulations and guidelines, including but not limited to, CMS, AHA and HCA policies and guidelines.
- Streamlined account resolution processes, leading to increased efficiency and reduced turnaround times.
Prior Authorization Coordinator
1 Year- Responsible for obtaining prior authorizations for medications, procedures and diagnostic exams for the Oncology Department.
- Verified insurance benefits and eligibility, identifying authorization requirements before procedures and referrals.
- Abstracted and submitted required medical documentation for authorizations to support medical necessity.
- Investigated denied claims and worked closely with insurance carriers to promote resolutions.
- Assigned ICD-9, HCPCS, and CPT codes as appropriate based on information from the patient record.
- Responsible for initial and follow-up authorizations.
- Used Meditech to input claim, prior authorizations and other important medical data into the system.
- Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage and referred accounts to Client Services.
Education
Legal Assistant Certification
Associates Degree in Nursing - Nursing
Associate of Science - Respiratory Therapy
Skills
Policy interpretation
Teamwork
Advanced Case Management
Clinical & Internal Collaboration
Problem-solving
Multitasking skills
Critical thinking
Adaptability and flexibility
Analytical thinking
Certification
Certified Professional Coder (CPC-A). Credentialed by AAPC. License #01385574. Exp: 02/28/2026, Certified Professional Biller (CPB). Credentialed by AAPC. License #01385574. Exp: 02/28/2026
Timeline
Grievances and Appeals Representative IV
Humana
12.2025 - 08.2026Read More
Lead Managed Care Analyst
Revecore
10.2020 - 07.2025Read More
Coding Account Resolution Specialist
Parallon Business Solutions
10.2015 - 03.2020Read More
Prior Authorization Coordinator
St. Claire Regional Medical Center
10.2014 - 10.2015Read More
Morehead State University
Associate of Science from Respiratory Therapy
Read More
Social Security Administration
Legal Assistant Certification
Read More
Marshall University
Associates Degree in Nursing from Nursing
Read More