Shannon Stake
Titan Health Management Solutions Inc.
Sunbury,PA
1
Certification
15
years of professional experience
Resourceful and results oriented professional with over 29 years of experience in the healthcare industry and office setting. I am proficient in software management systems, Certified Medical Coder, self-motivated, trusted, and independent.
Hardworking and passionate job seeker with strong organizational skills eager to secure position. Ready to help team achieve company goals.
Work History
Reimbursement Auditor
1 Year 10 Months- Currently role is a reimbursement auditor for Honor Health Healthcare Hospitals. zero balance team. Currently, review healthcare claims that have a $0 balance to recover overlooked revenue, from underpayments to incorrect write offs. Analyze claims for contract compliance, determine if errors are payer side (processing mistakes) or provider-side (coding errors, missing charges). Prepare customized appeal letters and submit to insurance companies to reclaim underpaid funds.
- Titan Healthcare Zero Balance Team
Payor Collections Specialist
2 Years 5 Months- As a payer collection specialist reviewed post-submission medical billing and insurance accounts receivable (AR). My primary goal was recovering outstanding money from insurance companies and government payers, reducing aging reports, and resolving claim denials or payment discrepancies to optimize cash flow. I made calls to Insurance Companies, Local Jails and ICE Detention Facilities as well as Patients for Outstanding Claims and Coordination of Benefits Issues related to outstanding revenue.
Senior Reimbursement Services Coordinator
10 Years 6 Months- Served as one of the lead consultants and educators to staff and administration for related reimbursement, strategic savings initiatives, and coding compliance issues. Asses existing and prospective reimbursement practices. Provide appropriate reimbursement recommendations based on current contracts, policies and accepted industry practices while ensuring compliance with contractual, state and federal regulations.
- Develop and demonstrate exceptional competence and expertise in all reimbursement methodologies and relevant industry information.
- Understanding of current and future reimbursement strategies and concepts.
- Keep fully informed of current and expected changes in Medicare and other third-party payer reimbursement regulations and advise leadership on possible effects.
- Oversee the delegation of responsibilities for assuring all new codes are revised in addition to appropriate fee schedules to maintain compliance with federal requirements.
- Review of reimbursement opportunities by utilizing statistical reports, reimbursement summary documents and chart auditing outcomes, to conduct reviews and analysis of coding practices and fee levels in determining appropriateness of coding practices and fees of the provider network.
- Assist in recovery of inappropriately billed charges.
- Oversee the implementation of operational changes that occur due to reimbursement changes.
- Health Plan Configuration and Operations Dept., Reimbursement Services
Education
High School Diploma - General Studies
Diploma Received
Skills
Microsoft Suite Products – Excel
Outlook
Teams and Access. Epic
Availity
Chat GPT
Various Insurance Payor Portals ie: Optum
BCBS of AZ
United Healthcare
Cigna
Encoder Pro
Noridian
Certification
- May 2016 – Received Certificate of Healthcare Management: An Introduction (AHM 250) AHIP – America’s Health Insurance Plans
- June 2012 – Received Certificate of ICD-10 Proficient – American Academy of Professional Coders
- August 2005 – Received CPC Certification – American Academy of Professional Coders – August 2005 to Present
Timeline
Reimbursement Auditor
Titan Health Management Solutions Inc.
2025.01 - CurrentRead More
Payor Collections Specialist
Christus Healthcare SE Texas
2022.08 - 2025.01Read More
Senior Reimbursement Services Coordinator
Geisinger Health Plan
2011.05 - 2021.11Read More
Shikellamy High School
High School Diploma from General Studies
Read More