Shelby Gunn
San Antonio
Summary
Experienced denial management specialist with strong track record in healthcare claims processing and resolution. Skilled in analyzing and addressing claim denials, ensuring compliance with industry regulations, and optimizing reimbursement processes. Known for effective team collaboration, adaptability to changing needs, and results-driven approach. Proficient in utilizing medical coding systems, insurance protocols, and data analysis tools.
Overview
6
6
years of professional experience
Work History
Claims Data Analyst
University Health System
10.2022 - 11.2024
- Expedited claims resolutions for improved customer satisfaction through thorough investigations and timely communications.
- Managed high-volume caseloads for optimal productivity while maintaining strict attention to detail.
- Developed a comprehensive understanding of ICD-10-CM, CPT, and HCPCS codes to ensure proper use in medical coding assignments.
- Managed a portfolio of key accounts, ensuring all claims data analysis needs were met in a timely and accurate fashion.
Data Analyst
USAA
09.2020 - 12.2022
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Expedited claims resolution by effectively collaborating with providers and payers to obtain necessary documentation or missing information.
- Played a key role in improving the organization’s overall financial performance, minimizing lost revenue due to denied claims.
Medical Claims Examiner
Health Texas
11.2018 - 08.2020
- Enhanced claim processing efficiency by conducting thorough investigations and maintaining accurate documentation.
- Supported team members during periods of high workload, providing guidance on challenging cases or offering assistance when needed.
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Improved claim processing efficiency by implementing new medical claims examination practices and procedures.
- Handled complex claim issues, effectively communicating with patients, providers, and insurance companies to ensure resolution.
Education
High School Diploma - High School & College
Macarthur High School
San Antonio, TX06-2013
Skills
- Customer Service
- Healthcare Reimbursement
- Medical Record Review
- Appeals Processing
- ICD-10-cM coding
- Claims Processing
- Medical Billing Software
- HCPCS coding
- Microsoft Excel
- Denial Management
- Call Center Experience
- Claims Analysis
Timeline
Claims Data Analyst
University Health System
10.2022 - 11.2024
Data Analyst
USAA
09.2020 - 12.2022
Medical Claims Examiner
Health Texas
11.2018 - 08.2020
High School Diploma - High School & College
Macarthur High School
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