Sharon Hill-Clethen
Wesley Chapel,FL
Summary
Organized [Medical and Billing Pre-Authorization Specialists] with foundation in records management. Experienced in billing and collection procedures. Advanced medical terminology knowledge. Medical billing and coding specialist with 20] years providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private insurance processes and codes. Devoted personal care professional skilled in fostering client health and convenience through assisting with daily activities and health needs. Driven to promote healthy habits to encourage client well-being by demonstrating healthy habits. Dedicated to applying emerging techniques to derive best possible outcomes. Sympathetic personal care aide with several years of experience supporting patients with activities of daily living. Professional and clear communicator when instructing and assisting patients as well as when reporting information to healthcare team and supervisors.
Overview
24
24
years of professional experience
Work History
Caregiver, Special Needs
Agent for Veteran Directed Care Program
Wesley Chapel, FL
10.2023 - 07.2024
- Provided assistance to special needs individuals with daily activities such as feeding, bathing and dressing.
- Assisted in the development of life skills such as communication and mobility.
- Transported clients to appointments or other destinations using a wheelchair accessible vehicle.
- Developed positive relationships with families of special needs individuals.
Infant Nanny
Kristyn Gilmore
Wesley Chapel, FL
01.2023 - 11.2023
- Ensured that all necessary supplies were available at all times including diapers, wipes.
- Monitored the infant's daily activities such as eating, sleeping patterns, hygiene habits.
- Provided a safe environment for the children through supervision and guidance of their activities.
- Observed developmental milestones and reported any concerns to parents immediately.
Toddler Nanny
Kristina Salerno
Tampa, FL
12.2022 - 01.2023
- Performed light housekeeping duties related to childcare such as laundry or meal preparation.
- Read stories aloud to the children and engaged them in creative play activities.
- Monitored the children's playtime to ensure safety and wellbeing.
- Planned age-appropriate activities to help foster physical, mental, and emotional development.
- Instructed the children in proper behavior, manners, health habits.
Family Nanny
Dr. Adetola Jean-Louis
Tampa, FL
06.2019 - 08.2021
- Took initiative in researching new ways to engage the children through educational activities outside of the home setting.
- Supervised play dates with other families while adhering to safety guidelines.
Senior Customer Service Data Entry Representative
CSI Medical Temps for KePRO
Tampa, FL
12.2009 - 05.2011
- Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms)
- Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
Senior Customer Service Representative
CCS Medical
Clearwater, FL
02.2009 - 04.2009
- Precisely completed appropriate claims paperwork, documentation and system entry
- Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms)
- Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation
- Maintained updated knowledge of coding requirements, through continuing education and certification renewal
- Adeptly managed a multi-line phone system and pleasantly greeted all patients
- Verified patients' eligibility and claims status with insurance agencies
- Diligently filed and followed up on third party claims
- Determined prior authorizations for medication and outpatient procedures
- Coordinated luncheons with Pharmaceutical Representatives
- Researched questions and concerns from providers and provided detailed responses
- Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data
- Maintained strict patient and physician confidentiality
- Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing
- Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories
- Managed collections claims for unpaid bills against the estates of debtors
- Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations
- Submitted electronic/paper claims documentation for timely filing
- Accurately posted and sent out all medical claims
- Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services
- Precisely evaluated and verified benefits and eligibility
- Responded to correspondence from insurance companies
- Posted and adjusted payments from insurance companies
- Identified and resolved patient billing and payment issues
- Maintained and updated collections tracking spreadsheet to help organize payment information
- Confidently and adeptly handled claim denials and/or appeals
- Evaluated patients' financial status and established appropriate payment plans
- Reviewed and resolved claim issues captured in TES/CLAIMS edits and the clearing house
- Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable
- Updated patient financial information to guarantee accuracy
- Treated all patients, their families, visitors, peers, staff and providers in a pleasant and courteous manner
- Accurately posted surgeries, hospital visits and payments for assigned carriers
- Prepared billing correspondence and maintained database to organize billing information.
Insurance Claims Customer Service Representative
Tampa Community Health Center
Tampa, FL
10.2000 - 04.2001
- Precisely completed appropriate claims paperwork, documentation and system entry
- Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge
- Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms)
- Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation
- Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
Customer Service Data Entry Medical Records Clerk
KePRO
Tampa, FL
- Coded inpatient charts at a rate of number per hour or number per day
- Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms)
- Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation
- Pre-certified medical and radiology procedures, surgeries and echocardiograms
- Coordinated luncheons with staff and guests
- Maintained strict patient and physician confidentiality
- Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories
- Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
Claims Representative for The New England Health Insurance Company
Health Plan Services
Tampa, FL
- Precisely completed appropriate claims paperwork, documentation and system entry
- Correctly coded and billed medical claims for various hospital and nursing facilities
- Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge
- Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms)
- Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation
- Maintained updated knowledge of coding requirements, through continuing education and certification renewal
- Verified patients' eligibility and claims status with insurance agencies
- Entered orders into the EMR system efficiently and without errors
- Diligently filed and followed up on third party claims
- Prepared patient charts, pre-admissions and consent forms as necessary
- Assigned appropriate medical codes with a number percent accuracy rate
- Determined prior authorizations for medication and outpatient procedures
- Researched questions and concerns from providers and provided detailed responses
- Accurately selected the proper descriptive code when more than one anatomical location was indicated
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy
- Maintained strict patient and physician confidentiality
- Resourcefully used various coding books, procedure manuals and on-line encoders
- Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing
- Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories
- Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations
- Responded to correspondence from insurance companies.
Lead Associate of Customer Service Insurance Collector/Biller/Mailroom Clerk
St. Joseph's Hospital
Tampa, FL
- Correctly coded and billed medical claims for various hospital and nursing facilities
- Precisely completed appropriate claims paperwork, documentation and system entry
- Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge
- Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms)
- Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation
- Maintained updated knowledge of coding requirements, through continuing education and certification renewal
- Verified patients' eligibility and claims status with insurance agencies
- Entered orders into the EMR system efficiently and without errors
- Diligently filed and followed up on third party claims
- Prepared patient charts, pre-admissions and consent forms as necessary
- Compiled necessary documents for surgical billing packages
- Assigned appropriate medical codes with a number percent accuracy rate
- Determined prior authorizations for medication and outpatient procedures
- Pre-certified medical and radiology procedures, surgeries and echocardiograms
- Coordinated luncheons with Pharmaceutical Representatives
- Coded Observation/Inpatient Professional Services at a rate of 11 per hour
- Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data
- Researched questions and concerns from providers and provided detailed responses
- Accurately selected the proper descriptive code when more than one anatomical location was indicated
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy
- Maintained strict patient and physician confidentiality
- Resourcefully used various coding books, procedure manuals and on-line encoders
- Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing
- Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories
- Initiated, performed and documented quarterly coding audits for physicians
- Managed collections claims for unpaid bills against the estates of debtors
- Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations
- Submitted electronic/paper claims documentation for timely filing
- Accurately posted and sent out all medical claims
- Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services
- Precisely evaluated and verified benefits and eligibility
- Responded to correspondence from insurance companies
- Posted and adjusted payments from insurance companies
- Identified and resolved patient billing and payment issues
- Maintained and updated collections tracking spreadsheet to help organize payment information
- Confidently and adeptly handled claim denials and/or appeals
- Evaluated patients' financial status and established appropriate payment plans
- Reviewed and resolved claim issues captured in TES/CLAIMS edits and the clearing house
- Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable
- Updated patient financial information to guarantee accuracy
- Treated all patients, their families, visitors, peers, staff and providers in a pleasant and courteous manner
- Compiled and tracked outstanding balances owed to medical facilities
- Accurately posted surgeries, hospital visits and payments for assigned carriers
- Printed and reviewed monthly patient aging report and solicited overdue payments
- Prepared billing correspondence and maintained database to organize billing information.
Insurance Billing and Collection Medical Records Data Entry
St. Joseph's Women's Hospital
Tampa, FL
- Correctly coded and billed medical claims for various hospital and nursing facilities
- Precisely completed appropriate claims paperwork, documentation and system entry
- Coded inpatient charts at a rate of number per hour or number per day
- Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge.
Claims Representative for The New England Health Insurance Company
Health Plan Services
Tampa, FL
- Precisely completed appropriate claims paperwork, documentation and system entry
- Correctly coded and billed medical claims for various hospital and nursing facilities
- Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge
- Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms)
- Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation
- Maintained updated knowledge of coding requirements, through continuing education and certification renewal
- Verified patients' eligibility and claims status with insurance agencies
- Entered orders into the EMR system efficiently and without errors
- Diligently filed and followed up on third party claims
- Prepared patient charts, pre-admissions and consent forms as necessary
- Assigned appropriate medical codes with a number percent accuracy rate
- Determined prior authorizations for medication and outpatient procedures
- Researched questions and concerns from providers and provided detailed responses
- Accurately selected the proper descriptive code when more than one anatomical location was indicated
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy
- Maintained strict patient and physician confidentiality
- Resourcefully used various coding books, procedure manuals and on-line encoders
- Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing
- Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories
- Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations
- Responded to correspondence from insurance companies.
Education
Medical Administration: Medical front office administration -
Concorde Career College
Tampa, FL01.1991
High School Diploma -
Leto Comprehensive High School
Tampa, FL01.1974
Skills
- Organized
- Medical and Billing Pre-Authorization Specialists
- Experienced in billing and collection procedures
- Advanced medical terminology knowledge
- Medical billing and coding specialist
- 20 years providing administrative and patient support
- Advanced knowledge of private insurance processes and codes
- Billing and collection procedures expert
- Records management professional
- Hospital inpatient and outpatient records
- Medical terminology expert
- ICD-10 (International Classification of Disease Systems)
- DRG and PC grouping
- Understands insurance benefits
- Composed and professional demeanor
- Research and data analysis
- Resourceful and reliable worker
- Excellent problem solver
- Adept multi-tasker
- Office support (phones, faxing, filing)
- Excellent verbal communication
- Inpatient records coding proficiency
- Records maintenance professional
- Outpatient surgery coding specialist
- Patient referrals expert
- HCPCS Coding Guidelines
- Understands anesthesia coding
- Familiar with commercial and private insurance carriers
- Patient chart auditing ability
- Dermatology billing expertise
- Behavioral health billing and collections
- Personal care assistance
- Feeding Assistance
- Emotional Support
- Social Skills Development
- Housekeeping
- Schedule Maintenance
- Convalescence Support
Gap in Job History
May 2011 I took early retirement and cared for my dear mother until she passed away. This will explain my employment gap through the year 2019.
Timeline
Caregiver, Special Needs
Agent for Veteran Directed Care Program
10.2023 - 07.2024
Infant Nanny
Kristyn Gilmore
01.2023 - 11.2023
Toddler Nanny
Kristina Salerno
12.2022 - 01.2023
Family Nanny
Dr. Adetola Jean-Louis
06.2019 - 08.2021
Senior Customer Service Data Entry Representative
CSI Medical Temps for KePRO
12.2009 - 05.2011
Senior Customer Service Representative
CCS Medical
02.2009 - 04.2009
Insurance Claims Customer Service Representative
Tampa Community Health Center
10.2000 - 04.2001
Customer Service Data Entry Medical Records Clerk
KePRO
Claims Representative for The New England Health Insurance Company
Health Plan Services
Lead Associate of Customer Service Insurance Collector/Biller/Mailroom Clerk
St. Joseph's Hospital
Insurance Billing and Collection Medical Records Data Entry
St. Joseph's Women's Hospital
Claims Representative for The New England Health Insurance Company
Health Plan Services
Medical Administration: Medical front office administration -
Concorde Career College
High School Diploma -
Leto Comprehensive High School
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