Shelby McLaren
Stockton,CA
Summary
Highly proficient dedicated Customer Service / Medical Billing Specialist with experience in a fast paced, multiple client medical billing company. 12+ Years in the medical industry and customer service on all levels from customer to provider to facility side. Passionate employee wanting to use skills and abilities to grow success within a company.
Overview
6
6
years of professional experience
Work History
CUSTOMER SERVICE LEAD/PROVIDER APPEALS SPECIALIST
Blue Shield of California
03.2020 - 11.2023
- Resolved customer service issues using company processes and policies and provided updates to customers.
- Enhanced customer satisfaction by resolving complex issues and providing timely solutions.
- Trained, oversaw, and mentored new team members to strengthen performance and job expertise.
- Handled escalated customer complaints professionally, ensuring prompt resolution and follow-up actions were taken as necessary.
- Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
- Consistently met or exceeded performance metrics, demonstrating a strong understanding of the claims review process and an unwavering commitment to achieving positive results for clients.
- Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
- Expedited resolution times for appeals cases by efficiently managing workload and prioritizing urgent matters.
- Educated clients on their rights and responsibilities throughout the appeals process, ensuring a clear understanding of expectations and potential outcomes.
- Improved the appeals success rate by researching legal precedents and staying up-to-date with current industry regulations and guidelines.
- Reduced claim denial rates with thorough pre-appeal reviews, identifying potential issues before submission.
- Created, composed and maintained appeal response templates.
- Developed appeals functions, policies and procedures and documentation.
SURGICAL COORDINATOR/MEDICAL BILLER
MEDICAL BILLING AND CODING
Stockton, CA
01.2018 - 03.2020
- Efficiently managed high volume caseloads while maintaining meticulous attention to detail in scheduling logistics and documentation.
- Maintained strict adherence to HIPAA regulations, protecting the privacy of patient information at all times.
- Enhanced surgical team communication by maintaining accurate schedules and promptly addressing any changes or concerns.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
Education
Carrington College
Skills
- Appeals analyst
- Appeals commercial/private insurance
- Member appeals
- Provider appeals
- Claim submission appeals
- Customer Service
- Medical billing
- Insurance verification
- Insurance claims processing
- Work Coordination
- Operations Support
- CPT Knowledge
- Excellent Communication
- Account updating
- Effective Communication
- Insurance Billing
- Claim submission
- Medical Terminology
- Correspondence
- Billing Data Verification
- Insurance Claims
- CMS-1500 Billing Forms
- Provider/facility accounts
- Medical terminology
- Analytical Skills
- Data security procedures
- Problem-Solving
- Collections Management
- Electronic Claims
- Medicare and Medicaid process
- Billing and Invoicing
- Billing statement review
- Attention to Detail
- Medical coding knowledge
- Customer Relations
- Customer Account Management
- Payment posting
- Patient Billing
Awards
4.0 Deans list graduate
Timeline
CUSTOMER SERVICE LEAD/PROVIDER APPEALS SPECIALIST
Blue Shield of California
03.2020 - 11.2023
SURGICAL COORDINATOR/MEDICAL BILLER
MEDICAL BILLING AND CODING
01.2018 - 03.2020
Carrington College