SHERAN MCPHAIL
DARLINGTON,S.C.
Summary
Dedicated professional seeking a challenging and motivational position to advance career. Adept at meeting needs, enhancing processes, and surpassing expectations within team settings. Diligent worker with excellent communication and task prioritization abilities.
Overview
33
33
years of professional experience
1
1
Certification
Work History
PROFESSIONAL CLAIMS PROCESSOR II
HUMANA GOVERNMENT BUSINESS
FLORENCE SC
02.2021 - Current
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing meet deadlines.
- Scan medical records into system
- Update and load cmns as well medical information
- Process specialty claims as in ABA, DEERS ENROLLMENT, DME,
- Work special projects...PROVIDER FILE, BABY HELMET, DUPLICATES, T5 AUDITS, CORRESPONDENCE
- Managed claims entry tasks.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
BILLING SPECIALIST
HOPEHEALTH
FLORENCE, SC
07.2019 - 10.2020
- Analyzed claims to ensure accuracy and completeness.
- Reviewing patient bills for accuracy and completeness, and obtaining any missing information
- Executed follow-up on unpaid claims to maintain compliance with billing cycle standards.
- Handled telephone communications to address questions from patients and insurance providers on account matters.
- Billed secondary and tertiary insurances.
- Researching and appealing denied claims
- Processed invoices for specialized programs such as hop, bcn, and marketplace plans.
- Processed and divided FQHC claims for billing.
- Scan, appeal, print. submit medical records
- Processed various insurance types including primary, VA, commercial, supplemental, Medicare, and Medicaid.
PATIENT ACCOUNT REP/BILLER
MCLEOD REGIONAL MEDICAL CENTER
FLORENCE, SC
12.2014 - 07.2019
- Revise and adjust and rejected claims to process for payment
- Supported patients in resolving account-related phone queries.
- Delivered exceptional customer support.
- Processed medical updates and appealed denied claims.
- Validated patient benefits and insurance coverage.
- Handled payment transactions accurately.
- Contact insurance companies to process or adjust claims
- Handled submission of medical records for appeal processing.
- Handled various claims including VA, workers' compensation, primary and secondary Medicare, and Medicaid.
- Entered claims data accurately.
- Escalated cases to coders for further evaluation when necessary
REGISTRATION REPRESENTATIVE
MCLEOD REGIONAL MEDICAL CENTER
FLORENCE, S.C.
07.2011 - 12.2014
- Provide excellent customer service
- Assist patients and family members through registration
- Get patient insurance and demographic info, pre register and admit patients, register ems through emergency situations
- Confirm active status of insurance.
- Collect payments and verify benefits
- Maintained patient confidentiality by adhering to HIPAA regulations and securing sensitive information.
- Enhanced patient satisfaction by providing clear communication, answering queries, and addressing concerns in a timely manner.
- Reduced wait times for patients by consistently processing registrations promptly and efficiently.
RURAL MAIL CARRIER
UNITED STATES POSTAL SERVICE
TIMMONSVILLE, S.C.
03.2010 - 07.2012
- Delivered mail to residences and business establishments along specified routes by walking and driving, using a combination of satchels, carts, and cars
- Recorded address changes and redirected mail for those addresses
- Sold stamps and money orders
- Sorted mail for delivery, arranging it in delivery sequence
- Consistently met delivery deadlines through effective time management skills and prioritization of tasks.
- Kept vehicle clean and well-maintained, conducting regular inspections for any necessary repairs or maintenance needs.
- Adapted quickly to changing conditions due to weather or traffic, adjusting routes as needed while maintaining punctuality in deliveries.
- Directly interacted with customers to deliver mail, packages, and ordered goods.
- Collected mail from letter boxes on specific route both on foot and by vehicle.
- Delivered registered and certified mail items with care, ensuring proper documentation was obtained upon receipt from recipients.
CUSTOMER SERVICE REPRESENTATIVE
TEMPORARY JOB WITH OLSTENS STAFFING
FLORENCE, S.C.
09.2009 - 09.2009
- Outbound calls, verify insurance, data entry, customer service
CLAIMS ASSOCIATE
BLUECROSS BLUESHIELD
FLORENCE, S.C.
03.2001 - 05.2008
- Executed daily operations of checking systems for errors so customer payments are issued correctly
- Organized, reviewed, and validated data for accuracy before entry.
- Successfully handled calls to doctor offices and beneficiaries about status or problems with claims. Check to ensure that appropriate changes were made to resolve customer's problems
- Detected errors by comparing entered data with original source documents.
- Execute ICD9, CPT4 AND HCPCS coding
- Coding and keying of physician billing HCFA 1500 and hospital bills UB92
- Utilized modifiers effectively.
- Resolve all errors when claims edits for deferral
- Verified and reprocessed claims for accurate payment distribution.
- Contacted providers to gather incomplete data.
- Contributed to departmental goals by consistently meeting or exceeding individual performance metrics for both quality and quantity of processed claims.
INVENTORY MANAGER
RACETRACK PETROLEUM
FLORENCE, S.C.
12.1998 - 03.2001
- Estimated consumer demand and determined the types and amounts of goods sold
- Examined merchandise to ensure that it was correctly priced and displayed and that it functioned as advertised
- Reviewed inventory and sales records to prepare reports for management and budget departments
- Inventoried stock and reordered when inventory dropped to a specified level
- Maintained sufficient inventory levels to meet customer demands at all times.
- Coordinated with suppliers to guarantee timely delivery of inventory and materials.
ASST MANAGER
SCOTCHMAN STORES
FLORENCE, S.C.
08.1995 - 03.1998
- Instructed staff on how to handle difficult and complicated sales
- Provided customer service by greeting and assisting customers, and responding to customer inquiries and complaints
- Successfully handled cash/credit/debit transactions
- Executed daily operations by putting sales into computer as daily reports and invoices
- Maintained a clean, safe, and organized store environment to enhance the customer experience.
- Supervised day-to-day operations to meet performance, quality and service expectations.
FOOD PREP/COOK
QUINCY'S FAMILY STEAKHOUSE
FLORENCE, S.C.
03.1992 - 01.1994
- Baked breads, rolls, cakes, and pastries
- Washed, peeled, cut, and seeded fruits and vegetables to prepare them for consumption
- Responsible for keeping hot/cold food bars clean and neat
- Baked, roasted, broiled, and steamed meats, fish, vegetables, and other foods
Education
Certificate - Comprehensive Medical Coding, Ins and Billing
FLORENCE DARLINGTON TECHNICAL COLLEGE
FLORENCE, SC01.2020
Certification - Medical Coding Physician Billing for CPC
NANCY SCHOOL OF MEDICAL CODING
COLUMBIA, S.C.01.2015
National Certification Licenses - EKG, Phlebotomy, Nursing Asst., CPR, Advance Nursing
PROFESSIONAL MEDICAL CENTER
FLORENCE, S.C.01.2010
Certificate - Medical Terminology
CARVER COMMUNITY SCHOOL
FLORENCE, S.C.01.1998
Diploma - undefined
TIMMONSVILLE HIGH
TIMMONSVILLE, S.C.01.1994
Skills
- Claims review
- Accuracy and precision
- Transactions reconciliation
- Claims
- Professionalism and ethics
- Regulatory compliance
- Medical terminology
- Data entry
- Critical thinking
- Claims adjustment
- Claims processing
- Insurance coverage verification
Certification
RECEIVED STATE LICENSE FOR EKG, NURSING ASSISTANT PHLEBOTOMY, CPR
Timeline
PROFESSIONAL CLAIMS PROCESSOR II
HUMANA GOVERNMENT BUSINESS
02.2021 - Current
BILLING SPECIALIST
HOPEHEALTH
07.2019 - 10.2020
PATIENT ACCOUNT REP/BILLER
MCLEOD REGIONAL MEDICAL CENTER
12.2014 - 07.2019
REGISTRATION REPRESENTATIVE
MCLEOD REGIONAL MEDICAL CENTER
07.2011 - 12.2014
RURAL MAIL CARRIER
UNITED STATES POSTAL SERVICE
03.2010 - 07.2012
CUSTOMER SERVICE REPRESENTATIVE
TEMPORARY JOB WITH OLSTENS STAFFING
09.2009 - 09.2009
CLAIMS ASSOCIATE
BLUECROSS BLUESHIELD
03.2001 - 05.2008
INVENTORY MANAGER
RACETRACK PETROLEUM
12.1998 - 03.2001
ASST MANAGER
SCOTCHMAN STORES
08.1995 - 03.1998
FOOD PREP/COOK
QUINCY'S FAMILY STEAKHOUSE
03.1992 - 01.1994
Certification - Medical Coding Physician Billing for CPC
NANCY SCHOOL OF MEDICAL CODING
Certificate - Medical Terminology
CARVER COMMUNITY SCHOOL
Diploma - undefined
TIMMONSVILLE HIGH
Certificate - Comprehensive Medical Coding, Ins and Billing
FLORENCE DARLINGTON TECHNICAL COLLEGE
National Certification Licenses - EKG, Phlebotomy, Nursing Asst., CPR, Advance Nursing
PROFESSIONAL MEDICAL CENTER