Sheconda Lallemand
Opa-locka,FL
Summary
Highly motivated, dependable, and demonstrates professionalism in handling various organizational functions and providing administrative support critical to organizational success with proven ability to thrive in busy environments with positive results. Innovative and reliable individual with proven ability to achieve organizational goals while displaying effective multi-tasking and time management skills. Excellent analytical skills with keen attention to detail, ability to analyze situations, and research information to develop sound and ethical business solutions. A team player with effective interpersonal and communication skills, adept at building productive relationships and building rapport with a diverse set of individuals at all levels from diverse cultural and socio-economic backgrounds. Authorized to work in the US for any employer
Overview
19
19
years of professional experience
Work History
CRC MSP Outreach Analyst
Performant Financial Corp.
Remote
05.2019 - Current
- Review account claim and other documentation to verify payment liability for claims that may have been paid by Medicare in error
- Leverage your knowledge and expertise in medical billing/COB/MSP to review documentation and claim billing, build the case file to determine/validate liability, evaluate and respond to defenses refuting payment liability, status the account and initiate appropriate letter correspondence, answer questions and/or provide information that will bring to successful payment or other appropriate account action
- Initiate correct action with applicable party (health insurance carrier, auto/home/worker's comp insurance carrier, or legal representative) and documentation based upon payment option, actions required if new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay
- Updates client and/or company systems with clear and accurate information such as contact and updated demographic information, notes from contact dialog and attempts, payment commitment, as well as account status updates as applicable
- Initiates applicable claim activities; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures
- Support internal groups or functions with interpretation of EOB (explanation of benefits), as well as development of knowledge base and understanding of key concepts and terminology in healthcare billing and claims
- Arrives to work on-time, works assigned schedule, and maintains regular good attendance
- Follows and complies with company, departmental and client program policies, processes and procedures
- Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations
- Successfully completes, retains, applies and adheres to content in required training as assigned Consistently achieve or exceed established metrics and goals assigned, including but not limited to, production and quality
- Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and, successfully passes and/or obtains and maintains clearances statuses as a condition of employment
- (note: client/government clearance requirements are not determined or decisioned by Performant.) Demonstrates Performant core values in performance of job duties and all interactions
- Correct areas of deficiency and oversight received from quality reviews and/or management
- Work overtime as may be required
- May be required to work some Performant holidays due to client requirement
- Performs other duties as assigned.
Billing Rep//Reimbursement Specialist II
Envision Physician Services
Plantation, FL
11.2016 - 05.2019
- Using coded data to produce and submit claims to insurance companies
- Working directly with the insurance company, healthcare provider, and patient to get a claim processed and paid
- Reviewing and appealing unpaid and denied claims
- Verifying patients' insurance coverage
- Answering patients' billing questions
- Handling collections on unpaid accounts
- Managing the facility's Accounts Receivable reports.
General Surgery/Dermatology Patient Access Rep.
Premier Medical Group
Clarksville, TN
09.2014 - 08.2016
- Working directly with the insurance company, healthcare provider, and patient to get a claim
- Verifying patients' insurance coverage
- Answering patients' billing questions
- Handling collections on unpaid accounts
- Managing the facility's Accounts Receivable reports.
- Using coded data to produce and submit claims to insurance companies
- Applied HIPAA privacy and security regulations while handling patient information.
- Communicated financial obligations to patients and collected fees at time of service.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
- Responded to patient inquiries regarding billing or financial matters.
- Scanned documents into electronic medical records system.
ER Patient Access Rep
Gateway Medical Center
Clarksville, TN
01.2013 - 06.2013
- Managed verifications of Insurance
- Collected patient's liability and performed compliance check for all Medicare patient
- Collected and validated patient demographic and insurance information
- Obtained health, financial and religious information from patients at the time of admission
- Performed patient pre-admission, admission, transfer, and discharge activities
- Obtained signatures for financial responsibility and treatment procedures from patients or guardians.
- Registered patients by completing face-to-face interviews to obtain demographic, insurance, and medical information.
- Applied HIPAA privacy and security regulations while handling patient information.
- Processed patient responsibility estimate determined by insurance at pre-registration.
- Reviewed eligibility responses to assess patient benefit level and prepare estimates.
- Performed pre-registration functions such as verifying demographic information, obtaining authorizations, and collecting deposits and co-payments.
- Created new patient accounts in EMR system as needed.
Channel Sales Group Supervisor
American Medical Depot
Mismi, Florida
12.2010 - 05.2012
- Monitored and rated sales calls and customer service issues to be later used in trainings for continuous improvement.
- Conducted “module” calls on a weekly basis-promoting and bringing in leads to our vendors on their most current medical equipment and/or instrumentation.
- Provided extensive customer service and handled customer issues for the companies fast-paced department.
- Assisted the department manager with department payroll
- Extensive Order Entry
- Supervised and lead an inside sales/customer service team of seven (7).
- Reviewed and approved all outbound proposals to customers before sending.
Invoiced both customers and vendors in a timely manner. - Responsible for recruiting new department team members.
- Ensuring company and department policies were followed and implemented accordingly
Effectively handled 40-60 inbound calls daily which consisted of customer orders, returns, product concerns and questions, tracking and tracing, proposal request and pricing.
Managed over 40 Department of Defense (D.O.D) accounts and was responsible for the company’s biggest D.O.D accounts while maintaining our current relationship and growing business.
ER Registrar, Patient Access Rep
Jackson North Medical Center
Miami, FL
09.2005 - 05.2012
- Served as Lead for weekend shift
- Handled Patient Registration, verification of insurance and collections of patient liability
- Created daily reports and conducted training to new staff
- Responded to patient concerns and inquiries professionally
- Performed compliance Checker for all Medicare patients
- Maintained positive working relationships with patients, physicians, visitors, and hospital staffs
- Handled chart preparation for next day visits and performed lead duties
- Oversaw patient registration time
- Interacted with hospital administrations to perform effective patient operations
- Ensured compliance with hospital policies and procedures and adhered to government regulations.
Education
High School Diploma - General Studies
Miami Central Senior High School
01.1998
Skills
- Organizational Leadership
- Administrative Functions
- Time Management
- Client Relationship Planning/Coordinating
- Customer Service
- Daily Operations Management
- Records Management
- Work Flow Administration
- Interdepartmental Coordination
- Patient Care
- Policy & Procedure Compliance
- Documentation And Reporting
Timeline
CRC MSP Outreach Analyst
Performant Financial Corp.
05.2019 - Current
Billing Rep//Reimbursement Specialist II
Envision Physician Services
11.2016 - 05.2019
General Surgery/Dermatology Patient Access Rep.
Premier Medical Group
09.2014 - 08.2016
ER Patient Access Rep
Gateway Medical Center
01.2013 - 06.2013
Channel Sales Group Supervisor
American Medical Depot
12.2010 - 05.2012
ER Registrar, Patient Access Rep
Jackson North Medical Center
09.2005 - 05.2012
High School Diploma - General Studies
Miami Central Senior High School
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