SHEREMA BARBOUR
Port Charlotte,FL
Summary
Detail-oriented Healthcare Operations Specialist skilled in prior authorizations, denial follow-up, and revenue cycle support. Recent Medical Coding & Billing training enhances expertise in CPT and ICD-10, ensuring compliance with payer guidelines and accurate documentation for reimbursement. Demonstrates adaptability in fast-paced environments while delivering high-quality results under pressure.
Overview
1
1
Certification
19
19
years of professional experience
Work History
PRIOR AUTHORIZATION & REVENUE BILLING CYCLE SPECIALIST
Southwest Florida Pain
, Florida
01.2025 - Current
- Manage high-volume prior authorizations for complex interventional pain musculoskeletal
- Review provider documentation to validate medical necessity in accordance with payer-specific guidelines prior to submission.
- Submit, track, and follow up on authorizations through TurningPoint, Cohere, eviCore, and major commercial payer portals.
- Coordinate and schedule peer-to-peer reviews between providers and insurance medical directors when required.
- Prepare and submit first-level and reconsideration appeals for denied authorizations with supporting CPT and ICD-10 documentation.
- Monitor authorization expirations to prevent procedure delays and revenue disruption.
- Maintain detailed authorization tracking logs and communicate status updates to clinical and billing teams.
- Partner with revenue cycle staff to reduce denials and improve clean claim submission rates
FRONT DESK SUPERVISOR
Uptown Pediatrics
New York, NY
01.2012 - 01.2025
- Led front-office operations for a 7-provider pediatric practice serving high daily patient volume.
- Supervised and trained front desk staff, enhancing workflow efficiency and increasing patient satisfaction.
- Trained and supervised front desk staff, evaluating performance and guiding professional development.
- Managed appointment scheduling and insurance pre-authorizations, including MRI and radiology procedures.
- Managed insurance verification, imaging authorizations, and front-end revenue cycle functions.
- Oversaw coding and billing (CPT, ICD-10), account updates, and front-desk financial collections.
- Entered and reviewed CPT and ICD-10 codes and collaborated with the billing department to resolve claim denials.
- Implemented scheduling improvements that reduced patient wait times and improved provider productivity.
- Served as primary liaison for patient concerns, facilitating service recovery and improving patient experience.
- Contributed to policy creation and staffing optimization, implementing best practices to enhance operations.
FRONT DESK SUPERVISOR/AUDIT SUPERVISOR
Esplanade Hotel
White Plains, NY
01.2009 - 01.2013
- Led a team of 10 front desk professionals in a high-volume hospitality environment, ensuring exceptional guest service.
- Collaborated with hotel leadership to streamline operations and uphold service standards.
- Oversaw secure management of cash deposits, invoices, and audit documentation to maintain financial integrity.
- Managed deposits, billing adjustments, and financial documentation.
- Conducted nightly financial audits and reconciliations to ensure reporting accuracy.
RESERVATIONS AGENT
Crowne Plaza Hotel
White Plains, NY
01.2008 - 01.2009
- Managed high-volume reservations and group bookings, ensuring seamless service through Opera system.
- Delivered exceptional guest service and resolved conflicts, enhancing guest satisfaction and experience.
- Coordinated logistics and staff activities for hospitality events, contributing to successful execution.
Education
Medical Coding & Billing Diploma -
Penn Foster
New York, NY01-2025
High School Diploma -
Gorton High School
Yonkers, NY01-2003
Skills
- Payer Portals: TurningPoint, Cohere, EviCore, Availity, Carelon, Radmd
- Medical Necessity & Payer Guidelines
- Denial management
- Claims Analysis
- Coding accuracy
- HCPCS coding certification
- Revenue Cycle Management
- Insurance guidelines knowledge
- Billing Process Improvement
- Patient Advocacy
- Patient Experience & Satisfaction
- Scheduling & Workflow Coordination
- Workflow Optimization
- Multi-Line Phone & EHR Systems
- EMR Systems (Epic, EncounterPro, PCC, CareCloud)
- Peer-to-Peer Coordination
- Staff Development
- Policy & Procedure Development
- Provider communication
- Medical Office Administration
Certification
CPC Exam – Scheduled / Pending (AAPC), CNA Certification (Expired)
Timeline
PRIOR AUTHORIZATION & REVENUE BILLING CYCLE SPECIALIST
Southwest Florida Pain
01.2025 - Current
FRONT DESK SUPERVISOR
Uptown Pediatrics
01.2012 - 01.2025
FRONT DESK SUPERVISOR/AUDIT SUPERVISOR
Esplanade Hotel
01.2009 - 01.2013
RESERVATIONS AGENT
Crowne Plaza Hotel
01.2008 - 01.2009
Medical Coding & Billing Diploma -
Penn Foster
High School Diploma -
Gorton High School