Shauna-Kay Thomas-Scott
Monroe
Summary
Experienced with managing revenue cycles, ensuring efficient billing and collections processes. Utilizes analytical skills and attention to detail to resolve payment issues and optimize financial performance. Track record of fostering team collaboration and adapting to dynamic healthcare environments.
Overview
11
11
years of professional experience
Work History
Buisness Operation Rep III
Finthrive
07.2023 - Current
- Developed training materials to support new team members in understanding product offerings.
- Increased revenue by identifying and resolving billing errors in a timely manner.
- Served as a liaison between clinical departments, finance, and administration, ensuring smooth communication for proper revenue cycle management.
- Ensured accurate billing with thorough audits of patient accounts and insurance claims.
- Balanced and reconciled accounts.
- Improved cash flow with diligent follow-up on pending claims and appeals processes.
Medical Billing Specialist
Carbon Health
06.2021 - 03.2023
- Reviewed patient accounts to ensure accuracy and completeness of information
- Assisted with the development of new processes for billing, coding, collections, and reimbursements
- Analyzed claims data to identify trends in denials and rejections
- Processed appeals related to denied or rejected claims in a timely manner
- Provided training sessions on billing software applications and procedures to staff members
- Monitored accounts receivables daily to determine appropriate follow-up action needed
Grievance And Appeals Specialist
Emblem Health
03.2019 - 07.2021
- Conduct thorough investigations of all member and provider correspondence by analyzing all the issues involved and obtaining responses and information from internal and external entities
- Serve as liaison with Emblem Health departments, delegated entities, medical groups and network physicians to ensure timely resolution of cases
- Research appeal files for completeness and accuracy and investigate deficiencies
- Consult with internal areas as required (such as the Legal Department) to clarify legal ramifications around complex appeals
- Follow-up with responsible departments and delegated entities to ensure compliance
- Accurately and completely prepare cases for medical and administrative review detailing the findings of their investigation for consideration in the plan's determination
- Monitor daily and weekly pending reports and personal worklists, ensuring internal & regulatory timeframes are met
- Analyzed managed care contractual issues, provided feedback to the Credentialing Department
- Applied provider payments on accounts, applying contractual managed care reimbursement rates
- Correct coding errors Experience with Next Gen
Credit And Collection Analyst
POM LLC
06.2018 - 11.2018
- Managed a diverse portfolio of accounts, ensuring appropriate actions were taken to maintain financial health.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Filed and updated patient information and medical records.
- Ensured timely payments from insurance providers through submission of accurate and complete claims.
- Collected payments and applied to patient accounts.
Accounts Receivable Rep II
Northwell Health
10.2016 - 03.2018
- Managed complex problem-solving for upper management in order to complete projects on-time and within budget.
- Implemented new accounting processes to decrease spending and work flow downtime.
- Posted payments and collections on regular basis.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
Charge Entry Specialist
Care Mount Medical
11.2013 - 10.2016
- Expedited payment collection by submitting clean claims for reimbursement from insurance companies and patients promptly.
- Answered questions and assisted providers and office staff.
- Reduced errors in charge capture by maintaining up-to-date knowledge of CPT, ICD-10, and HCPCS codes.
- Ensured compliance with billing guidelines by staying current on relevant regulations, policies, and procedures.
Education
Bachelor Of Science - Health Administration
University Of Phoenix
Remote04-2026
High School Diploma -
St. Catherine High
Jamaica, West Indies06.2007
Skills
- Collecting payments
- Analytical Problem Solving
- Verifying insurance
- Insurance Verification
- Contractual Compliance
- Claim Verifications
- Claims Files Management Processes
- HIPAA Compliance
- Medical terminology understanding
- Clerical Support
- Insurance claims processing
- Medicaid and Medicare Knowledge
- Medical Billing
Timeline
Buisness Operation Rep III
Finthrive
07.2023 - Current
Medical Billing Specialist
Carbon Health
06.2021 - 03.2023
Grievance And Appeals Specialist
Emblem Health
03.2019 - 07.2021
Credit And Collection Analyst
POM LLC
06.2018 - 11.2018
Accounts Receivable Rep II
Northwell Health
10.2016 - 03.2018
Charge Entry Specialist
Care Mount Medical
11.2013 - 10.2016
High School Diploma -
St. Catherine High
Bachelor Of Science - Health Administration
University Of Phoenix
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