Shardae Murray
Charlotte
Summary
Resourceful customer service professional with a strong background in medical billing, claims examination, and processing. Striving to exceed the needs of customers, clients, and businesses. With 16 years of experience in the healthcare and insurance industry, main objectives have been focused on claims management and providing exceptional customer service. Excels at multitasking and meeting all policy and statutory deadlines. Quick to learn new products and programs while building strong relationships with customers. Known for maintaining a high level of professionalism and patience. Highly accountable and dependable, authorized to work in the US for any employer.
Overview
18
18
years of professional experience
Work History
Medical Biller
07.2023 - Current
- Perform analytical work of denied claims
- Research insurance payer requirements
- Solving problems and finding innovative solutions
- Ability to prioritize multiple responsibilities
- Making and receiving calls with a professional demeanor
- Understanding reimbursement policies
- Comfort with technology
- Monitor reports to identify trends, concerns and/or areas of improvement
- Discuss findings with the potential of reporting up to management
- Process requests for medical records by verifying the authorization for release in compliance with federal and state laws, as well as healthcare facility policies.
- Retrieve patient information from electronic health records (EHR) and paper-based systems to fulfill information requests accurately and efficiently.
- Redact confidential information from the patient’s health records as required by HIPAA guidelines to protect patient privacy before releasing the information.
- Utilize specialized software to log and track requests and releases, ensuring timely processing and compliance with regulatory timeframes.
- Communicate with healthcare providers, patients, and third parties to clarify requests and ensure the correct information is released.
Reimbursement Case Manager
TrialCard, Inc-Aston Carter
05.2023 - 07.2023
- Completed data fields within ERP system with insurance benefit information, including risk entity, estimated Out Of Pocket expenses, deductible met, authorization start & end dates, and others
- Prepared correspondence to insurance companies, Health Care Professionals (HCPs) & other affiliates on behalf of patients, such as authorization requests, appeals & letters of agreement
- Clearly documents all correspondence in the company databases helped to create, provide or request forms to collect clinical data on patients
- Troubleshoot and sought solutions to problems related to questions and concerns over health insurance coverage and explanation of benefits, orders and sales efforts
- Acted as a single point of contact and voice for all providers and patients.
- Served as a patient advocate and enhances the caller/contact experience
- Coordinated access to therapies, conducts appropriate follow up and facilitates access to appropriate support services
- Determined patient’s eligibility and conducts patient enrollment activities (example patient assistance programs and copay assistance)
- Performed reimbursement related activities such as benefit investigations, prior authorizations, appeals, etc.
- Extensive knowledge of HIPAA regulations and follows all company policies
- Performed related duties as assigned
Care Manager-Benefits Investigator
Aston Carter-IQVIA
11.2022 - 05.2023
- Responsible for contacting insurance companies to obtain correct eligibility information, perform benefit investigations, copay assistance, and check prior authorization and/or appeal status.
- Completed data fields within ERP system with insurance benefit information, including risk entity, estimated Out Of Pocket expenses, deductible met, authorization start & end dates, and others
- Prepared correspondence to insurance companies, Health Care Professionals (HCPs) & other affiliates on behalf of patients, such as authorization requests, appeals & letters of agreement
- Clearly documents all correspondence in the company databases helped to create, provide or request forms to collect clinical data on patients
- Troubleshoot and sought solutions to problems related to questions and concerns over health insurance coverage and explanation of benefits, orders and sales efforts
- Acted as a single point of contact and voice for all providers and patients.
- Served as a patient advocate and enhances the caller/contact experience
- Coordinated access to therapies, conducts appropriate follow up and facilitates access to appropriate support services
- Determined patient’s eligibility and conducts patient enrollment activities (example patient assistance programs and copay assistance)
- Performed reimbursement related activities such as benefit investigations, prior authorizations, appeals, etc.
- Extensive knowledge of HIPAA regulations and follows all company policies
- Performed related duties as assigned
- Answered in-bound calls and assisting customers with pharmacy related services
Insurance Investigator
United Biosource Corporation
12.2021 - 10.2022
- Conducted benefit investigations, verified insurance benefits for patient and physicians’ offices, and submitted and obtained prior authorizations as required by payer; obtained recertification for cases requiring extended treatment/coverage beyond the expiration of original approval.
- Accurately entered and maintained data as required in client database and patient files and utilize the client database to monitor outstanding items on each client case file. Ensured files were complete so team can determine the current status.
- Participated in conference calls as needed with Client Sales Representatives, client management and physicians’ offices regarding status of cases, drug orders and status of alternative funding.
- Provided coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient.
- Identify and report events as required by the REMS requirements for specified medication. Recognize adverse event, product quality complaint, potential risk events, and forward information to the appropriate team member for reporting to the manufacturer.
- Educated patients, prescribers, and others regarding program requirements, and facilitate referrals.
- Maintained good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures.
Patient Case Coordinator
AmerisourceBergen
10.2014 - 10.2018
- Processed/approved/renewed patient applications for grants to help with co-pay assistant for medication due to terminal illness
- Complete data fields within ERP system with insurance benefit information, including risk entity, estimated Out Of Pocket expenses, deductible met, authorization start & end dates, and others
- Assisted patients with billing information and or grant information
- Provide quality customer service to increase customer satisfaction
- Answered basic clinical and program inquires
- Analyze claims and applications to see if medical records are needed and requested necessary records.
- Liaison between patient and pharmacy and managing assigned patient's care.
- Ensure accurate and timely completion of transactions to meet or exceed client service levels and resolved both routine and non-routine issues.
Patient Access Specialist
Providence Northeast Hospital
09.2013 - 07.2014
- Register new and existing patients that were admitted through the ER department.
- Perform pre-admission, admission, transfer, and discharge activities.
- Obtain health, financial and religious information from patients at the time of admission.
- Entered personal information, claims information, and other data related to the patient's care demographics, and insurance via EPIC.
- Scan in the appropriate documents for compliance purposes.
- Collect copays/co-insurance; verified patient's benefits online or via phone, and follow-up on pending accounts.
- Review and resubmitted denials for ER claims with updates/corrections to be made on the claim based on CLD/NCD policies, individual insurance carrier medical policies, and coding guidelines via EPIC.
- Work compliance with hospital policies and procedures and adhere to government regulations.
- Met individual and department standards with regards to both quality and productivity goals.
- Correct claim submission and knowledge of the Medicaid systems are integral to clinics and hospitals receiving payment. filed in a timely manner to get payment quickly.
Customer Service Advocate I
BC/BS of SC
01.2012 - 08.2013
- Provided prompt, accurate, thorough and courteous responses to all customer inquiries via phone, email, or correspondence
- Reviewed hospital and physician claims to determine why a code (diagnosis, HCPCS, CPT, etc.) has denied and resubmitted claims through adjudication with updates/corrections to be made on the claim based on CLD/NCD policies, individual insurance carrier medical policies, and coding guidelines.
- Analyzed claims to see if medical records are needed and requested records from patient and/or providers.
- Examined incoming medical records and sent appropriate records to medical review unit.
- Met individual and department standards with regards to both quality and productivity goals.
Claims Customer Service Representative
BC/BS of SC
08.2007 - 01.2012
- First point of contact for military insurance in high volume call center.
- Assist providers and beneficiaries by providing general information on benefits and processing claims productively.
- Reviewed hospital and physician claims to determine why a code (diagnosis, HCPCS, CPT, etc.) has denied and resubmitted claims through adjudication with updates/corrections to be made on the claim based on CLD/NCD policies, individual insurance carrier medical policies, and coding guidelines.
- Provided detail research on Third party liability cases (TPL), financial responsibility claims of another payer that have been mistakenly paid, or claims paid at the incorrect reimbursement rate.
- Identified and notified Operations manager or Claims lead of system related issues.
- Completed ongoing training in telephone skills, claims processing and responding to correspondence
- Maintained a personal monthly goal to enhance company productivity as a whole
Education
Diploma - general studies
Conway High School
Conway, SC06.2004
Skills
- Medical Billing & Claims Processing
- HIPAA Compliance
- ICD-10 & ICD-9 Coding
- EMR & EHR Systems
- EPIC
- Insurance Verification
- Customer Service & Support
- Time Management
- Documentation Review & Analysis
- Salesforce & Microsoft Office
- Prior Authorization & Benefits Verification
- Quality Control & Leadership
Languages
English - Fluent
Timeline
Medical Biller
07.2023 - Current
Reimbursement Case Manager
TrialCard, Inc-Aston Carter
05.2023 - 07.2023
Care Manager-Benefits Investigator
Aston Carter-IQVIA
11.2022 - 05.2023
Insurance Investigator
United Biosource Corporation
12.2021 - 10.2022
Patient Case Coordinator
AmerisourceBergen
10.2014 - 10.2018
Patient Access Specialist
Providence Northeast Hospital
09.2013 - 07.2014
Customer Service Advocate I
BC/BS of SC
01.2012 - 08.2013
Claims Customer Service Representative
BC/BS of SC
08.2007 - 01.2012
Diploma - general studies
Conway High School
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