SHANNON R. MARTIN
PITTSBURGH,PA
Summary
Perform duties and responsibilities in a fashion which coincides with the healthcare service management philosophy of the career I obtain and or achieve.
Highly organized professional with proven track record in coordinating complex tasks and ensuring seamless operations. Adept at managing schedules, resources, and stakeholders to achieve project goals effectively. Renowned for fostering teamwork and adapting to dynamic environments, making significant contributions to organizational success.
Self-motivated [Job Title] brings proven leadership, organizational and customer relations skills. Independently solves problems and keeps teams on task to handle diverse business requirements. History retaining clients and talented staff.
Overview
27
27
years of professional experience
Work History
Intake/ Auth Coordinator/ Collections Specialist
Synergy Billing Corp.
03.2020 - Current
- Collect on insurance balances from highest dollar to oldest claims.
- Adhere to collection follow-up dates set.
- Appeal claims as needed.
- Work to keep A/R days under 120 days
- Follow up and resolve all insurance denials
- Work on patient referrals for Antibiotics, TPN/Enteral and Specialty Medications and request/ obtain authorizations for therapies.
Senior Hub Specialist
Blink Health
11.2019 - 02.2020
- Verify insurance benefits for PBM's, bill claims electronically.
- Work with patients to obtain insurance info, answer incoming telephone inquiries and resolve customer issues.
- Work with pharmacists to update RX's timely and ship orders.
- Suggest ideas and update SOP's to streamline our processes.
- Work special projects as assigned by management.
- Assist in training of new hires and maintain smooth onboarding process for them.
Benefit Verification Specialist
Connective RX
07.2019 - 10.2019
- Verify insurance benefits for MS drugs, Supprelin LA, Xiaflex and various other medications.
- Work on special projects as assigned.
- Follow up with patient's, manufacturers' and prescriber's on referrals.
- Deliver benefits to the patient, assist with copay programs, assist with patient assistance programs for all drug therapies.
Patient Access Representative III Lead
Acredo Health Group
01.2006 - 05.2019
- Obtaining accurate benefit information for the new referrals that we receive for PAH medications that are very expensive and we must have this information accurate to ensure payment accordingly.
- Responsible for obtaining reauthorizations efficiently on patients that are on service with us as these drugs are life-sustaining and can’t be interrupted.
- Responsible for negotiating with non-contracted payers by obtaining a letter of agreement and receiving the highest level of reimbursement for ATI.
- Responsible for setting up the claim centers correctly and making sure we use the correct contract pricing or request a new pricing be added to our system if an LOA is done.
- Responsible for working on at least 5 CODS (change of details) per week and these must be completed in a 10-day turnaround time.
- Responsible for working our hold report daily and prioritizing the issues to work first based on the oldest outstanding on our AR and maintaining and working the issues so they are resolved, and we can obtain reimbursement for ATI promptly.
- Maintaining the cod log and hold report.
- Answering questions to all other SCS’s that I oversee.
- Auditing other’s work to make sure is accurate.
- Handling the Patient Assistance Program for Flolan and Remodulin.
- Responsible for troubleshooting for issues that may affect our overall business as a whole and working special projects.
- Handling all International patients with each Country’s embassy.
- Working our WIP report daily to ensure referrals are being followed up on timely.
- Knowledge of ICD-10, CPT-4 coding and extensive knowledge of medical terminology.
- Knowledge of Copay Assistance Programs.
Customer Service Representative
AIG Agency Auto
07.2005 - 01.2006
- Responsible for all incoming calls from insurance agents for 37 different states nationwide and maintaining quality customer service.
- Maintaining high call volume quotas daily.
- Understanding and knowledge of AIG underwriting guidelines in the states we write within and processing changes on policies received from agents or insureds.
Customer Service Representative III/ Medical Biller and Collections
UPMC Physician Services
03.1999 - 05.2005
- Responding to all telephone inquiries in a positive manner in all situations along with handling website email inquiries from patients and or insurance carriers, etc.
- Training of all new staff members and demonstrating the basics of customer service to the best of my ability. Responsible to answer all employees’ questions and also be a liaison to other departments.
- Responsible for working formal customer complaints and resolving in 7-10 days. Negotiating with non-contracted payers and receiving the highest level of reimbursement.
- Responsible for working with enrollments dept on claims not paid correctly. If not paid correctly, then would dispute with the payers as per what the contracts indicated and try and get them to pay accordingly and if problems legal would assist.
- Responsible for all coding review inquiries and resolving the issue and if need be would consult with coding department for assistance. Also had to maintain daily follow-up account quotas and call quotas. Also had to maintain monthly reports and work any other duties as delegated by my supervisor or manager.
Education
Diploma - Medical Assistant/Medical Biller Program
ICM School of Business
Pittsburgh, PA01.1996
Skills
- Proficient in task management
- Customer service
- Data entry
- Decision-making
Timeline
Intake/ Auth Coordinator/ Collections Specialist
Synergy Billing Corp.
03.2020 - Current
Senior Hub Specialist
Blink Health
11.2019 - 02.2020
Benefit Verification Specialist
Connective RX
07.2019 - 10.2019
Patient Access Representative III Lead
Acredo Health Group
01.2006 - 05.2019
Customer Service Representative
AIG Agency Auto
07.2005 - 01.2006
Customer Service Representative III/ Medical Biller and Collections
UPMC Physician Services
03.1999 - 05.2005
Diploma - Medical Assistant/Medical Biller Program
ICM School of Business
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