Shanola R. Nunez
Columbia,MD
Summary
Results-oriented Revenue Cycle Professional with significant experience at Verbal Beginnings, specializing in revenue cycle management and effective team leadership. Proven track record in optimizing insurance coordination processes to enhance compliance and drive revenue growth. Expertise in ICD-9, ICD-10, and CPT coding, complemented by exceptional organizational and collaboration abilities. Aiming to leverage technical proficiency to further improve operational efficiencies in future roles.
Overview
25
25
years of professional experience
Work History
Insurance Coordination Manager
Verbal Beginnings
Columbia, MD
01.2022 - Current
- Provide strategic direction and leadership for the Insurance Coordination team, including benefit verification and insurance coordination, and support the billing function with denials and appeals
- Develop and implement financial policies, procedures, and best practices for effective and efficient insurance coordination
- Collaborate with executive leadership to align departmental financial goals with organizational strategy
- Oversee / manage the submission of authorization requests to various commercial payors and Medicaid programs following best practices and payor requirements
- Ensure all patients have authorization before services begin; work with families to obtain new or changed insurance information to avoid disruptions to care
- Work directly with clinical and operational leadership to address authorization or benefits issues
- Manage relationships with insurance providers and payers to ensure timely and accurate authorizations
- Stay abreast of changes in healthcare regulations and insurance policies, adjusting processes accordingly
- Resolve complex insurance issues and appeals related to the insurance coordination process
- Recruit, train, and manage a high-performing team of financial professionals
- Foster a positive and collaborative work environment
- Conduct regular performance evaluations and provide constructive feedback
- Ensure compliance with relevant healthcare regulations, including HIPAA and other industry standards
- Stay informed about changes in healthcare legislation and adapt departmental practices accordingly
Post-Acute Lead Insurance Coordinator
Adventist Home Health
Silver Spring, MD
01.2012 - 12.2021
- Develops and orients new Insurance Coordinators to ensure understanding of Post-Acute Insurance Benefit Check/Authorization Process
- Collaborates with PAC Center Supervisor and Manager to design and improve processes pertaining to Insurance Benefit Checks/Authorization, and their incorporation with the Intake Process
- Receives and accurately enters patient’s insurance information from Intake and Community Liaisons into the appropriate documentation system
- Verifies referred patient’s insurance benefits, obtains initial insurance precertification to provide post-acute services for Medicare, Medicaid and all other third-party payors
- Obtains third Party authorizations for additional visits & medical supplies for home health visiting staff/patients with appropriate documentation in EMR
- Track visits used by home health patients to ensure that they are within authorization limits set by the payors
- Serves as a consultant to patients and family members on updating their insurance information with employers, Social Security and CMS
- Provides insurance verification documentation as needed for denials as well as any other billing and collection to support Reimbursement Specialists
- Collaborates with all members of the PAC Center to facilitate patient’s smooth transition to the post-acute setting
- Obtain information from visiting staff on patient care needs relative to additional visits and medical supplies, established and keeps good relationships with case managers at the hospitals and insurance companies
- Keeps team up to date of any changes within the insurance companies and payer contracts, Trained all new Insurance Coordinators
- Made and maintained patient insurance files, Ordered and maintained all offices supplies, Verified doctors NPI and PECOS status
- Called hospitals and other homecare agencies to verify patient status when necessary
- Increase cash flow for the organization to invest and improve services to the community by timely notification of potential unauthorized visits
- Process change of payers timely to avoid any loss in revenue, Designated person from the department to sit in on managers meetings
- Track visits and medical supplies used by patients to ensure that they are within the payer’s authorization limits
- Advocate patient needs to insurance companies
Lead Reimbursement Specialist
Adventist Home Health
Silver Spring, MD
01.2007 - 01.2012
- Collected and checked all Assignment of Benefits forms
- Collected, copied, reconciled, and distributed all Explanation of Benefits to the proper person handling that insurance payer
- Generated, checked, and mailed patient co-pay and self-pay bills
- Made collection calls, worked with the collection agency and attorneys to collect outstanding balances
- Prepared accounts for collections
- Made patient financial charts
- Verified insurance benefits and eligibility via internet and telephone
- Obtained authorizations when necessary
- Ordered and maintained office supplies
- Prepared and made daily bank deposits
- Made court appearances with the company’s attorney
- Filed financial forms in charts
- Filed Charts
- Worked the switchboard
- Sent faxes and emails
- Composed memos, billed Medicare and third party insurances and followed up on outstanding claims not paid within 30 days
- Entered patient’s demographics into the computer system
- Brief payment posting
- Increase cash flow for the organization to invest and improve services to the community by filing claims and submitting appeals timely
- Held monthly A/R reviews with Reimbursement Manager to make sure any accounts over 90 days were cleaned up and monies collected
- Other duties as assigned
Administrative Assistant / Receptionist
01.2000 - 01.2007
- Checked patients in and out, Greeted patients upon arrival, Verification of demographics, Trained new employees, Assisted the front office administrator with reviewing resumes and setting up interviews, Answer phones, Make appointments, Confirmation of appointments, Scheduled surgeries, Assisted in the billing office with insurance verification and authorizations, Pulled charts for the next day and prepared charts for new patients, Entered the patients demographics into the computer system, called in prescriptions, helped triage patients, helped set up rooms for certain procedures, collected co-pays and outstanding balances, scheduled lunches and meetings with drug reps, sorted the mail, other duties as assigned
- Checked patients in and out, Greeted patients upon arrival, Verify patient’s demographic information as noted in chart, Verify current insurance information, Verification of HIPAA information in patient’s chart, Collected co-pay’s and any outstanding balances provided by billing office, Printed schedules and pulled charts for the next day, Prepared charts for new patients, Prepared medical records for patients, lawyers, doctors, and insurance companies, Verified insurance coverage, Filed medical records in patients’ charts, Entered patient’s demographics into the computer system, Answered phones and assist in billing office, called in prescriptions, helped triage patients, helped set up rooms for procedures, generated referrals for patients with HMO insurance carriers, ordered and maintained all office supplies, other duties as assigned
- Scheduled patients, Checked patients in and out, Collected co-pay’s and any outstanding balances provided by billing office, Prepared Charts for new patients, Prepared medical records for the patient, doctors, lawyers, and insurance companies, Verified insurance coverage, Entered patients demographic in the computer, Filed medical records in patient charts, Answer phones, Scheduled hospital procedures and obtained authorizations from insurance companies, Made and mailed new patient packets, Assist doctors when medical assistant is out, Assist in billing office when needed, set up rooms for procedures, called in prescriptions, triaged patients, sorted the mail, kept employee lounge clean, scheduled breakfast/lunch meetings for the doctors, ordered and maintained all office supplies, other duties as assigned
Education
Diploma - Medical Claims Billing and Coding
US Career Institute
01.2008
License -
Aspen Beauty Academy
Laurel, MD01.2003
Diploma -
High Point High School
Beltsville, MD01.2000
Certificate - Human Resource and Administrative Specialist Training
HPHS
Beltsville, MD01.2000
Skills
- Revenue Cycle Management Expertise
- Strong Organizational Skills
- Quick Learner
- Proficient in ICD-9, ICD-10, and CPT Coding
- Training and development
- Revenue growth
- Team leadership
- Time management
- Teamwork and collaboration
- Time management abilities
Timeline
Insurance Coordination Manager
Verbal Beginnings
01.2022 - Current
Post-Acute Lead Insurance Coordinator
Adventist Home Health
01.2012 - 12.2021
Lead Reimbursement Specialist
Adventist Home Health
01.2007 - 01.2012
Administrative Assistant / Receptionist
01.2000 - 01.2007
Diploma - Medical Claims Billing and Coding
US Career Institute
License -
Aspen Beauty Academy
Diploma -
High Point High School
Certificate - Human Resource and Administrative Specialist Training
HPHS
Similar Profiles
Margaret (Maggie) H. WhatleyMargaret (Maggie) H. Whatley
Junior Technician at Verbal BeginningsJunior Technician at Verbal Beginnings
Brittany LongmireBrittany Longmire
JuniorApplied Behavioral Analysis Therapist at Verbal BeginningsJuniorApplied Behavioral Analysis Therapist at Verbal Beginnings
Amber ThiesenAmber Thiesen
Field Coordinator at Verbal BeginningsField Coordinator at Verbal Beginnings