Sharon DeRose
King George,VA
Summary
Top notch medical claims specialist with a proven track record of claim resolution while adhering to contractual time limits and servicing a wide range of government and commercial payers.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Medical Claims Specialist
Surgical Center Of Central Virginia
06.2018 - Current
- Submitted electronic/paper claims documentation for timely filing.
- Monitored and updated claims status in claims processing system.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Followed up on denied claims to verify timely patient payment and resolution.
Conflict Resolution Manager
My Plumber Heating & Cooling
08.2016 - 04.2018
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
- Established team priorities, maintained schedules and monitored performance.
Collection Supervisor
United Consumers, Inc.
01.2007 - 08.2016
- Trained and mentored new employees on collection methods, documentation requirements and performance strategies.
- Supervised staff of collectors, monitoring phone calls and letters.
- Contacted customers to discuss late payments and options for remitting amounts due.
- Researched accounts and completed due diligence to resolve collection problems.
- Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
Collector
United Consumers, Inc.
01.2005 - 01.2007
- Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
- Contacted customers to discuss payment schedules and set up or immediately process payments.
- Persistently reached out to customers with extremely past due accounts to recover lost revenue.
- Negotiated re-payment plans by identifying causes of delinquent payments to assist in recovery of debt and meet realistic timeframes.
- Worked in call center environment handling manual and automatically dialed outbound calls.
Education
AS Liberal Arts General Studies -
Northern Virginia Community College
Woodbridge, VAMedical Coding and Billing -
Medical Institute of Health Technology
Lorton, VASkills
- Patient Admission
- Patient Data Management Systems
- Data Analysis
- Customer Service
- Telephone Etiquette
- Medical Terminology
- Insurance Policy Coverage Knowledge
- Thorough Claims Reviews
- Claim Validity Determination
- Insurance Claims Management
- HIPAA Procedures
Certification
ACA- FDCPA Certified Collector, ACA International
Additional Information
Utilized the following platforms: Waystar, Availity, Navinet, Advantix, specializing in government payers i.e. Medicare, Tricare East, Tricare West, Tricare For Life, Virginia Medicaid, Dual Plans, Optum VACCN, Champ VA, Selman Co
Career Accomplishments
- Awarded "Employee of the Year" twice as the top collector.
- Nominated "Employee of the Year" for outstanding customer service in dispute management.
- Awarded "Employee of the Month" for exceptional patient and family care.
- Awarded "Employee of the Year" for exceptional patient and family care.
Timeline
Medical Claims Specialist
Surgical Center Of Central Virginia
06.2018 - Current
Conflict Resolution Manager
My Plumber Heating & Cooling
08.2016 - 04.2018
Collection Supervisor
United Consumers, Inc.
01.2007 - 08.2016
Collector
United Consumers, Inc.
01.2005 - 01.2007
AS Liberal Arts General Studies -
Northern Virginia Community College
Medical Coding and Billing -
Medical Institute of Health Technology
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