Sheree Hicks
Summary
Acquire a challenging occupation within the HealthCare Industry with growth potential and longevity.
Over 11 years of healthcare-related experience. Proficient in all aspects of Biliing, reimbursement and extensive knowledge of Specialty Pharmacy. Over 6 years of customer’s services and organizational skills, and a methodical approach to responsibilities. Enthusiastic individual, with strong time and cost management skills, as well as the ability to develop a fun and safe working environment.
Overview
28
28
years of professional experience
Work History
Lead Team Member
CareCounsel (Stanford University)
05.2014 - 02.2025
- Worked through each required task and step in production processes.
- Oversaw training and development programs to enhance team skills and knowledge.
- Motivated and empowered team members to build customer satisfaction and loyalty to support retention and growth.
- Managed conflict resolution within the team to maintain a positive work environment.
- Resolved patients complaints and issues promptly, ensuring high levels of satisfaction.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Assisted with the development of new billing procedures and policies.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Handled billing related activities focused on medical specialties.
- Provided feedback on coding errors and discrepancies found in submitted claims.
- Modified and updated existing policies and claims to reflect change in beneficiary, amount of coverage or type of insurance.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Corresponded with insured or agent to obtain information or inform of account status or changes.
- Responded promptly to customer inquiries regarding claim status updates.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Verified patient eligibility for medical claims and determined benefit coverage.
- Accurately processed large volume of medical claims every shift.
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Adhered to HIPAA regulations while managing confidential patient information.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Examined claims, records and procedures to grant approval of coverage.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
Client Management Specialist (contracted)
Law Office of John Burris
Richmond
04.2013 - 12.2013
- Organized client meetings to provide project updates.
- Monitored operations and reviewed records and metrics to understand company performance.
- Manages client needs regarding service, trading, problem resolution and processing issues
- Analyze factual data, medical records, etc
- Determine preliminary damage assessments, groupings, etc
- Draft research and opinion memoranda
- Coordinates call management for complex service issues with PCG for the S (AE)
- Dealing daily with high volume of clients in a corporate legal department
- Assist clients with contracts in the database is essential
- Simple drafting and redlining solid with exposure to clients
- Also IP foreign filling with stock administration, corporate governance, international and domestic subsidiaries, and due diligence, handle the signature and workflow process, basic drafting off templates, and a strong exposure to NDAs proficient in using Outlook to schedule meeting and using excel to create reports
- Provided guidance and support to management staff in developing, implementing, and evaluating policies, procedures, and strategies.
- Created presentations highlighting key findings from research projects conducted by the department.
- Maintained accurate records of all personnel transactions including promotions, transfers, terminations.
Customer Services Acct Representative (temp)
Bracket US, Inc.
South San Francisco
11.2012 - 03.2013
- Assist customer service representative with challenging account information
- Extended fast turnaround results
- Ensured 100% customer satisfaction on every call
- Establish and maintain relationships with the public & private payers, hospitals and physicians and patients
- Review and follow up on daily reports, e-mails, and faxes
- Coordinate referrals, Implement and lead various projects
Radiology Biller/Follow Rep/Medical Coordinator
Children Hospital
Oakland
11.2009 - 04.2010
- Company Overview: (Kenneth Assoc.)
- Processed billings to patients and third party reimbursement claims
- Maintained supporting documentation files and current patient addresses
- Processed patient statements, key data, post transactions, and verified accuracy of input to reports generated
- Verified Insurance coverage and run daily Analysis Reports
- Made payment arrangements and made collection phone calls
- Prepared Legal Documents for litigation
- Researched and responded by telephone and in writing to patient inquiries regarding billing issues and problems
- Follow up on submitted claims
- Coordinate the intake and clearance of new referrals; procure financial, insurance and demographic information from the patient and/or referral source
- Verify primary and secondary insurance benefits and prescription card coverage(s), track all new referrals and distribute information with timely updates to appropriate staff
- Notify patients of eligibility and benefit verification information
- Proactively and continuously pursue required payer clearance information through all levels of payer administration/management until desired results are reached, including verification of in/out of network benefits, related coverage’s and reimbursement allowables
- Create reimbursement intake sheets for new patients, enter and update intake information into billing system, provide effective documentation notes and prepare routine reports for Manager as requested
- (Kenneth Assoc.)
Claim examiner
Cigna Health Care
Oakland
12.2008 - 10.2009
- Maintain relationships with contracted providers, both directly contracted and captivated
- Liaison between physicians and other units of the organization
- Respond to inquiries from providers contracting and related issues
- Originate negotiations and credentialing for new or established providers
- Identify physicians requiring credentialing site assessments
- Delegate/Coronate site visits with Provider Relation Coordinators
Authorization Follow up Rep
Children’s Hospital
Oakland
09.2008 - 12.2008
- Company Overview: (Kenneth Assoc.)
- Validates requests and authorizations for release of medical information according to established procedures
- Obtain all authorizations from various health plans including Medi-Cal and California Children’s Services
- Updating patient demographic and insurance
- Collecting co-payments and balances
- Pulling charts, Filing
- Contact referral sources to advise of referral status, and provide to the clinical team who will deliver the services requested
- Access national or regional account information, including the names of accounts and terms of the contracts as appropriate and communicate these conversations to branch and intake department staff as needed
- Work with Intake team, branch staff, and patients to identify potential solutions as problems are identified with payer sources
- (Kenneth Assoc.)
Claims Representative
Marin Individual Practice Assoc.
San Rafael
05.2006 - 08.2008
- Responsible for reviewing and processing medical claims from in/out patients in an accurate and timely manner
- Reviewed the claims submitted to ensure that proper guidelines have been followed
- Handled all critical incident claims and all Life Management claims
- Maintained high claims production and quality
- Handled authorizations and review benefits for payment
- Responsible for A/R collections from Medicare, Medicaid insurance & patients accts
- Coordinate effort with outside auditors, vendors related to claims such as HEDIS, RAPS, EDS
- Manage claim appeals and overpayment recovery processes including sending proper notifications in accordance with company policies instruction, and leadership to the Billing team; and support other accounting functions as needed
Alternative Coverage and Reimbursement Rep
Kaiser Permanente
Vallejo
02.2000 - 04.2006
- Maintain relationships with contracted providers, both directly contracted and capitates
- Liaison between Physicians and other units of the organization
- Respond to inquiries from providers contracting and related issues
- Originate negotiations and credentialing for new or established providers
- Identify physicians requiring credentialing site assessment
- Ability to educate patients on the following: Medicare Part D, Medical and other Public-Government Payers
Government Medical Biller
John Muir Hospital
Walnut Creek
08.1997 - 01.2000
- Billed insurance company and or patient, and post payments to patients’ accounts
- Verified Insurance coverage and run daily Analysis Reports
- Provide support and assist with facilitating accurate and timely submission of monthly invoices prepared by the Billing Team
- Perform follow-up collection efforts
- Interface and collaborate with Contract Specialists and Financial Analysts on a regular basis in support of operational and project management requirements
- Maintain electronic and hard copy files
- Responsible for various accounting functions to include reconciliation of monthly billed, unbilled items, and revenue recognition
- Manage system fee schedule creation and upload process to ensure fee schedules are established correctly in system
- Coordinate effort with outside auditors, vendors related to claims such as HEDIS, RAPS, EDS
- Manage claim appeals and overpayment recovery processes including sending proper notifications in accordance with company policies
- Instruction, and leadership to the Billing team; and support other accounting functions as needed
Education
Associate of Arts (AA) - Business Management
Contra Costa College
San Pablo, CA05.2012
Loan Processor/ Origination Certified -
American School of Mortgage Banking
Tustin, CA01.2005
Medical Billing Specialist Certificate -
Alvarado Campus
El Cerrito, CA01.2003
High School Diploma -
Kennedy High School
Richmond, CA06-1996
Skills
- Excellent communication skills
- Coaching
- Team motivation
- Feedback delivery
- Complaint resolution
- Work Planning and Prioritization
- Team Check-ins
- Performance improvement
- Staff training
- High work ethic
- Excellent data entry skills
- Willingness to get the job done
- Excellent interpersonal skills
- Excellent presentation skills
- Ability to handle a heavy caseload
- Ability to work well with all levels of management
- Experience in a fast paced environment
- Ability to meet deadlines
- Experience with Authorization and Referrals (OTR’s)
- Adherence to HIPPA guidelines/regulations
- Assist with training of New Claims Examiners
- Assist with training of Case Managers
- Assist with training of Territory Managers
- Assist with training of Reps
- Experience with electronic submission and resubmission of claims
- Knowledge of Medicare billing guidelines
- Knowledge of Commercial billing guidelines
- Excellent working knowledge of ICD-9 codes
- Excellent working knowledge of CPT codes
- Excellent working knowledge of HCPC
Timeline
Lead Team Member
CareCounsel (Stanford University)
05.2014 - 02.2025
Client Management Specialist (contracted)
Law Office of John Burris
04.2013 - 12.2013
Customer Services Acct Representative (temp)
Bracket US, Inc.
11.2012 - 03.2013
Radiology Biller/Follow Rep/Medical Coordinator
Children Hospital
11.2009 - 04.2010
Claim examiner
Cigna Health Care
12.2008 - 10.2009
Authorization Follow up Rep
Children’s Hospital
09.2008 - 12.2008
Claims Representative
Marin Individual Practice Assoc.
05.2006 - 08.2008
Alternative Coverage and Reimbursement Rep
Kaiser Permanente
02.2000 - 04.2006
Government Medical Biller
John Muir Hospital
08.1997 - 01.2000
Associate of Arts (AA) - Business Management
Contra Costa College
Loan Processor/ Origination Certified -
American School of Mortgage Banking
Medical Billing Specialist Certificate -
Alvarado Campus
High School Diploma -
Kennedy High School
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