Job Search Status
Open to workDesired start date: 2 weeks notice
Open To Work
Sheryl Neal
Houston,Texas
Work Preference
Summary
Achieved timely resolutions in daily collection operations across three healthcare facilities, resulting in enhanced account management.,Maintained compliance with industry regulations through effective filing of CMS and TDI complaints, safeguarding organizational integrity.,Enhanced billing accuracy through strategic oversight of managed care advantage contract knowledge, leading to fewer discrepancies.,Increased efficiency of inquiries with third-party insurance carriers via advanced digital communication channels, improving response times.,Accelerated claim resolution by effectively coordinating the acquisition of correspondence from insurance carriers and patients, minimizing delays.,Optimized departmental workflow by adeptly managing high call volumes and efficient data entry processes, improving productivity.,Strategized collection approaches by thoroughly auditing claims and monitoring insurance aging reports, enhancing recovery rates.,Improved patient experience through diligent supervision of insurance verification and clear communication regarding patient liabilities, fostering trust.
Overview
10
10
years of professional experience
Work History
Managed Care Appeals Specialist
Elevate PFS
06.2023 - Current
- Review day to day accounts with technical appeal denials
- Discuss denials with payers, negotiates settlements on outstanding claims
- Monitor outcomes of follow-up activities
- Review contracts and understand reimbursement for HMO, PPO, MCR and Medicaid
- Prepare appeals on denials for underpayments
- Problem solve, carry out duties to ensure the optimal outcome
- Identify and escalate consistent issues and trends with payers
- Assist with New Hire Training and Assessments
- Monthly payment check for several facilities
Insurance Resolution Specialist
Tyvan Billing/NutexHealth
04.2022 - 06.2023
- Negotiate Proposal with multiple payers
- Conduct timely inquiries with third party payer
- Follow-up with major payers on unresolved accounts
- File appeals
- Meet and exceed daily goals
- Edit and resubmit claims
Patient Account Resolution Specialist
Oakbend Medical Center
09.2021 - 04.2022
- Follow-up with major prayers on underpaid accounts
- File appeals with supporting documents
- Maintain daily excel spreadsheet
- Scan and file correspondence in patient account
- Adjust insurance and patient payments
- Meet and exceed daily goal
Commercial Medical Collections Specialist
Kindred Healthcare CBO
05.2016 - 04.2021
- Handled and monitored daily collection activities for three facilities
- Followed-up with major payers on outstanding accounts until resolved
- Filed CMS and TDI complaints
- Maintained knowledge of Managed Care Advantage Contracts
- Prepared Legal Packets
- Demonstrated ability to multitask; meet and exceeded daily goals
Education
Computer Office Specialist
Texas School of Business
Friendswood, TXSkills
Organizational growth
HIPAA compliance
Effective communication
Professionalism and ethics
Strong analytical skills
Continuous learning mindset
Negotiation techniques
Problem-solving capacity
Insurance policies
Teamwork
Teamwork and collaboration
Customer service
Problem-solving
Time management
Attention to detail
Problem-solving abilities
Multitasking
Organizing and prioritizing work
Reliability
Excellent communication
Critical thinking
Organizational skills
Active listening
Adaptability and flexibility
Verbal and written communication
Decision-making
Teamwork skills
Relationship building
Microsoft office
Computer proficiency
Documentation skills
Team building
Data entry
Task prioritization
Self motivation
Interpersonal skills
Analytical thinking
Conflict resolution
Goal setting
Risk assessment
Professionalism
Document review
Insurance claim forms review
Policy review
Insurance coverage verification
Continuous improvement
Adaptability
Denied claims identification
Office equipment operation
Claim amount calculations
Skilled in software
Collaborative relationships
Records management
Professional demeanor
Problem-solving aptitude
Data entry software
Dispute resolution
Information verification
Proficient in software
Medical terminology
Data entry proficiency
Appeals process proficiency
Healthcare regulations expertise
Multitasking Abilities
Team collaboration
Claims adjustment
Claims investigation
Documentation
Coverage determination
Time management abilities
Policy analysis
Billing software
Negotiation tactics
Timeline
Managed Care Appeals Specialist
Elevate PFS
06.2023 - Current
Insurance Resolution Specialist
Tyvan Billing/NutexHealth
04.2022 - 06.2023
Patient Account Resolution Specialist
Oakbend Medical Center
09.2021 - 04.2022
Commercial Medical Collections Specialist
Kindred Healthcare CBO
05.2016 - 04.2021
Computer Office Specialist
Texas School of Business