Shannon Wallace
Columbus,Ohio
Summary
Accomplished auditing professional polished in risk mitigation and cost reduction strategies. Completes audits for clients in diverse industries and executes planning strategies to enhance financial positions. Focuses on delivering high-quality results and producing exceptional work.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Quality Review and Audit Lead
Cigna-Evernorth
01.2022 - Current
- Audit projects for the client base to ensure new and existing benefits meet requirements
- Research, analyze, and track inquiries/questions
- Consult with our service partners to discuss client contracts
- Monitor daily inventory.
Eligibility Representative
Accredo Health Group
01.2020 - 01.2022
- Reviewed claim codes & authorization to ensure accuracy
- Facilitates cross-functional of drug issues & copay coverage
- Independently resolve essential patient fundamentals while acting as a SME
- Resolved complex issues that resulted in contractual reimbursement
- Assisted with Onboarding and individual specialties in the train-the-trainer (T3) program.
Dental Claim Specialist
The Ohio State University
01.2016 - 01.2020
- Reviewed and documented client need to determine possible corrective measures
- Analyzed root causes for remediation
- Performed localized audits
- Launched investigative measures to site proper grievance
- Responsible for managing aging A/R to ensure compliance.
Office Manager
Family Dental Care
01.2013 - 01.2016
- Managed ten employees, oversaw daily office activities, handled patient appointments, cancellations, and last-minute adjustments
- Created an effective learning atmosphere that respected people’s diversity and ideas by modeling respect for all employees and conveying confidence in their self-improvement
- Created and Implemented policies and procedures that ensured compliance with HIPAA regulations and other applicable laws
- Performed detailed financial analyses to ensure the dental office was meeting budget goals and objectives
- Developed and maintained relationships with dental insurance companies, resulting in improved and efficient reimbursement.
Education
Bachelor of Science in Health Information Management (HIM) -
FRANKLIN UNIVERSITY
Skills
- Results-oriented professional
- Excellent verbal and written communication
- Technical and analytical aptitudes
- Problem-solving skills
- HIPAA Security/Privacy
- Electronic Health Records (EHR)
- Request for Proposal (RFP)
- Legal and Ethical Issues in Health Care
- CPT, HCPCS, and ICD-10-CM Codes
- Clinical Documentation Improvement
- Strategic Thinking
- Risk Management
- Ethical standards
- Analytical mindset
Coursework
- HIPAA Security/Privacy
- Electronic Health Records (EHR)
- Request for Proposal (RFP)
- Legal and Ethical Issues in Health Care
- CPT, HCPCS, and ICD-10-CM Codes
- Clinical Documentation Improvement
Certification
- Registered Health Information Administrator (RHIA) 05/2024
Timeline
Quality Review and Audit Lead
Cigna-Evernorth
01.2022 - Current
Eligibility Representative
Accredo Health Group
01.2020 - 01.2022
Dental Claim Specialist
The Ohio State University
01.2016 - 01.2020
Office Manager
Family Dental Care
01.2013 - 01.2016
Bachelor of Science in Health Information Management (HIM) -
FRANKLIN UNIVERSITY
- Registered Health Information Administrator (RHIA) 05/2024
Similar Profiles
Maira PerezMaira Perez
Sr. Claims Analyst at Cigna-EvernorthSr. Claims Analyst at Cigna-Evernorth
Tracie DunhamTracie Dunham
Provider Data Lead Analyst at Cigna Health Group - EvernorthProvider Data Lead Analyst at Cigna Health Group - Evernorth
Allison GlackinAllison Glackin
Plan Implementation Lead Analyst at Evernorth Health Services (The Cigna Group)Plan Implementation Lead Analyst at Evernorth Health Services (The Cigna Group)