Shelia Slaughter
Greater Detroit,MI
Summary
An organized and detail oriented team player. A dependable candidate successful at managing multiple priorities simultaneously with a high degree of accuracy and a positive attitude. Passionate about customer satisfaction.
Overview
19
19
years of professional experience
Work History
Recovery Specialist
Optum
12.2017 - 06.2022
- Improved client satisfaction through timely communication and resolution of account discrepancies.
- Negotiated payment arrangements with customers, resulting in increased revenue and reduced delinquencies.
- Managed a high volume of accounts while maintaining a professional demeanor and attention to detail.
- Maintained detailed documentation on all case activities, ensuring compliance with industry regulations and company policies.
- Utilized strong negotiation skills to persuade debtors toward mutually beneficial payment plans or settlements, avoiding costly litigation when possible.
- Achieved consistent monthly goals by prioritizing tasks according to urgency and impact on overall business objectives.
- Established rapport with customers by displaying empathy and understanding, ultimately increasing the likelihood of payment resolution.
- Reduced outstanding balances by executing strategic follow-up calls and written correspondence.
Medical Claims Processor
Meridian Health Plan
12.2014 - 08.2015
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Monitored and updated claims status in claims processing system.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Reviewed provider coding information to report services and verify correctness.
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Collaborated with healthcare providers to ensure accurate billing information was submitted, resulting in fewer denied or delayed payments.
- Responded to correspondence from insurance companies.
- Maintained a thorough understanding of the intricacies involved in processing medical claims for diverse healthcare specialties, enabling accurate and efficient claim adjudication.
- Ensured compliance with all applicable regulations by maintaining strict adherence to HIPAA guidelines and company protocols when handling sensitive patient information.
- Processed insurance payments and maintained accurate documentation of payments.
- Maintained a high level of customer satisfaction by promptly addressing inquiries and resolving issues related to medical claims.
- Resolved discrepancies between billed amounts and allowed charges promptly by working closely with both providers and payers, minimizing delays in payment processing times.
- Followed up on denied claims to verify timely patient payment and resolution.
Medical Claims Specialist
Aerotek - Health Alliance Plan
11.2013 - 11.2014
- Achieved timely reimbursements for clients through keen understanding of insurance company protocols.
- Expedited claim resolution times with proactive communication between patients, providers, and insurance companies.
- Managed high volume of claims, consistently meeting deadlines without compromising accuracy or quality.
- Contributed to the overall financial stability of the healthcare facility by consistently meeting or exceeding billing and collection targets.
- Verified patient insurance coverage and benefits for medical claims.
- Monitored and updated claims status in claims processing system.
- Paid or denied medical claims based upon established claims processing criteria.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Responded to correspondence from insurance companies.
- Followed up on denied claims to verify timely patient payment and resolution.
- Identified and resolved discrepancies between patient information and claims data.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Group Service Representative
Blue Cross Blue Shield of Michigan
12.2003 - 02.2008
- Built lasting rapport with key decision-makers through consistent follow-up communication regarding their level of satisfaction with the provided services.
- Developed strong relationships with clients, leading to increased referrals and repeat business.
- Organized successful events as part of the group services package, enhancing client engagement and loyalty.
- Resolved complex issues with effective communication and problem-solving skills.
- Provided exceptional customer support, addressing concerns promptly and professionally.
- Delivered exceptional presentations during sales meetings that demonstrated the value of our company''s group services offerings.
- Coordinated with other departments to deliver comprehensive group services that met client needs and expectations.
- Collaborated with team members to ensure seamless delivery of group services.
- Handled customer inquiries and suggestions courteously and professionally.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Responded to customer requests for products, services, and company information.
- Clarified customer issues and determined root cause of problems to resolve product or service complaints.
- Participated in team meetings and training sessions to stay informed about product updates and changes.
Recruiting Assistant
DTE Energy
02.2010 - 08.2012
- Provided administrative support to the Human Resources Recruiting Department
- Coordinated all aspects of test scheduling-contacting candidate, communicated details of test, sent confirmation correspondence, reviewed and printed resumes, ensured that all departments involved received testing and interviewing information, completed and sent visitor information to security, greeted and escorted candidates to Human Resources, reserved conference rooms as needed
- Responded to all candidate inquiries regarding employment, jobs, interviews
- Dispositioned candidates in Taleo
- Sent external candidate applications through Credential Check
- Reviewed and flagged resumes and applications for recruiter follow-up and background checks
- Assisted in I-9 form completion
- Assisted with new hire orientation.
Appeals and Denials Specialist
Healthcare Support Staffing-Conifer
05.2017 - 10.2017
- Validated denial disputes and generated appeals for denied or underpaid claims
- Validated denial reasons and ensured that coding was accurate
- Escalated exhausted appeal efforts for resolution
- Worked payer projects as directed
- Researched contract terms/interpretated and compiled necessary supporting documentation for appeals
Grievances & Appeals Coordinator
The Jacobson Group -Evolent Health
10.2016 - 01.2017
- Processed clinical medical appeals and disputes
- Reviewed and screened cases to ensure that all pertinent information was included such as claims information, EOBS and medical records
- Conducted detailed audits on case files, ensuring accuracy and completeness of information for better decision making.
- Maintained comprehensive knowledge of regulatory guidelines to ensure compliance within the appeals department.
- Collaborated with cross-functional teams, resulting in improved communication and quicker resolutions.
- Ensured confidentiality of sensitive information by following strict security protocols throughout the appeals process.
Education
Bachelor's Degree -
University of Detroit
Skills
- Documentation abilities
- Settlement Negotiation
- Debt Negotiation
- Customer Service
- HIPAA compliance awareness
- Claim Denial Resolution
- Critical Decision-Making
- Cross-Functional Teamwork
- Problem-solving abilities
- Critical Thinking
Timeline
Recovery Specialist
Optum
12.2017 - 06.2022
Appeals and Denials Specialist
Healthcare Support Staffing-Conifer
05.2017 - 10.2017
Grievances & Appeals Coordinator
The Jacobson Group -Evolent Health
10.2016 - 01.2017
Medical Claims Processor
Meridian Health Plan
12.2014 - 08.2015
Medical Claims Specialist
Aerotek - Health Alliance Plan
11.2013 - 11.2014
Recruiting Assistant
DTE Energy
02.2010 - 08.2012
Group Service Representative
Blue Cross Blue Shield of Michigan
12.2003 - 02.2008
Bachelor's Degree -
University of Detroit
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