Shantelle Jackson
Newark,DE
Summary
Detail-oriented Health Insurance Specialist versed in researching and resolving complex issues on behalf of policyholders, companies and carriers. Bringing over 13 years of expertise in health insurance. I'm successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering several years of experience and willingness to take on any challenge.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Health Claim Specialist
HBCS
New Castle, DE
07.2018 - Current
- Documentation reviewed for accuracy and validity on updated systems.
- Verification of patient information by analyzing existing evidence on file.
- Generate, post and attached information to claim files upon carrier request.
- Assert strong knowledge of basic medical terminology to better understand services and procedures.
- Prepare insurance claim forms or related documents and reviewed for completeness.
- Resubmission of claims after editing or denied to achieve financial targets and reduce outstanding debt.
- Modified, updated and processed existing policies.
- Manage a high volume of in-bound and out-bound calls from patients, hospitals, and insurance carriers to resolve patient accounts and collect payment.
- Research alternate insurance or payment options available while navigating and updating multiple patient accounting systems
- Assess caller status to ensure the protection of patient privacy and compliance with State and Federal guidelines
Education
Medical Billing And Coding Certificate - Medical Claims Examination
Dawn Institute
Delaware04.2015
Skills
- Documentation Review
- Insurance Claim Forms Review
- Eligibility Determinations
- New Policies Processing
- Claim Validity Determination
- Claim Amount Calculations
- Coverage Determination
- Efficient Service
- Complex Problem-Solving
- Accounts Receivable
- Billing Software
- Work Organizing and Prioritizing
- Payment and Investigation Escalations
Certification
- Medical Coding/Billing Certification
Timeline
Health Claim Specialist
HBCS
07.2018 - Current
Medical Billing And Coding Certificate - Medical Claims Examination
Dawn Institute
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