Shawi Washington
Letohatchee,AL
Summary
Proven track record in enhancing collections and claim resolutions, demonstrated throughout professional career with a 20% increase in collections. Expert in medical billing & coding and appeals management, coupled with exceptional attention to detail and effective communication. Achieved a significant reduction in settlement times, showcasing adaptability and a commitment to excellence.
Overview
10
10
years of professional experience
Work History
Worker Compensation and MVA Claims Analyst
QMACS, INC
07.2023 - Current
- Monitors and pursues revenue on outstanding workers' compensation and motor vehicle accident claims, resulting in a 20% increase in collections.
- Contacts patients, carriers, and adjusters to obtain necessary claim information for medical bill submissions, ensuring timely and accurate processing.
- Researches workers' compensation claims for reconsiderations or formal appeals, successfully overturning 75% of initial denials.
- Negotiates settlements for MVA claims with an approximate amount of 60-75% of the billed charges and Workers' Compensation claims, achieving an average reduction of 15% in settlement times.
- Disputes denials and examined claims for underpayments based on current fee schedules, recovering over $50,000 or more in underpaid claims.
- Adjudicates claims, ensuring compliance with company policies and regulatory standards, and maintaining a 95% accuracy rate in account closures.
Claims Research Associate
Apex Systems
03.2023 - 07.2023
- Processed and resubmitted workers' compensation claims for adjudication, reducing the average claim resolution time by 25%.
- Conducted comprehensive reviews of denied workers' compensation claims and routed them for clarification, resulting in a 40% increase in successful appeals.
- Verified required documents to ensure resolution and customer satisfaction, achieving a 90% customer satisfaction rate.
- Adjudicated claims according to appropriate guidelines, maintaining compliance with all regulatory requirements and company policies.
Workers' Compensation Analyst
Aspirion Health Resources
05.2021 - 03.2023
- Verified and obtained claim status via telephone, web portals, or fax, improving follow-up efficiency by 20%.
- Conducted thorough analysis of aged workers' compensation claims to ensure maximum reimbursement before deadlines, recovering over $100,000 in overdue payments.
- Maintained detailed records and updated weekly spreadsheets tracking account status, reducing errors by 15%.
- Researched accounts to determine if EMR was needed for claim resolution, leading to a 10% increase in claim resolution speed.
- Adjudicated claims to ensure the legality of regulatory standards, increasing the accuracy and efficiency of claims processing.
- Reviewed questionable claims by conducting reviews with claimants and employers to correct omissions and errors.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Medical Secretary
Fresenius Medical Care NA
04.2020 - 10.2020
- Managed front desk operations efficiently while greeting patients warmly and addressing their concerns professionally.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Maintained a clean and organized office environment to promote a positive atmosphere for both staff and patients.
- Assisted with administrative functions related to patient care, streamlining office operations and reducing wait times.
- Scheduled patient appointments as requested by physicians, improving patient scheduling efficiency.
- Obtained medical records for accurate medical assessments, ensuring 100% compliance with patient privacy regulations.
- Maintained inventory for medications and office supplies, reducing supply shortages.
- Registered new patients and explained treatment forms, enhancing patient onboarding experience and satisfaction.
Personal Aide
LPHCS
04.2014 - 11.2019
- Coordinated daily and weekly schedules for elderly clients and aides, improving care consistency and client satisfaction.
- Assisted with bathing, exercise, and meal preparation, contributing to improved client health and well-being.
- Transported clients to and from medical appointments, ensuring timely arrival and adherence to medical schedules.
- Documented daily vital signs and medical concerns, providing critical information to primary physicians for better care.
- Assisted with payroll and time sheets, ensuring accurate and timely payment for all aides.
- Accompanied the owner to assess potential new cases of client care to expand clientele by 15%.
Education
Associate of Applied Science - Healthcare Management
The College of Health Care Professions
Houston, TX11.2024
Skills
- Microsoft Office Proficiency
- Medical Billing & Coding Knowledge
- Strong Attention to Detail
- Effective Communication
- ICD-9 and ICD-10 Comprehension
- Appeals and Denial Management
- Analytical Skills
- Adaptability and Flexibility
- Team Collaboration
- Critical Thinking
- EMR/EHR Systems
- Customer Service Excellence
Timeline
Worker Compensation and MVA Claims Analyst
QMACS, INC
07.2023 - Current
Claims Research Associate
Apex Systems
03.2023 - 07.2023
Workers' Compensation Analyst
Aspirion Health Resources
05.2021 - 03.2023
Medical Secretary
Fresenius Medical Care NA
04.2020 - 10.2020
Personal Aide
LPHCS
04.2014 - 11.2019
Associate of Applied Science - Healthcare Management
The College of Health Care Professions
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