Shirl Dore
San Diego,CA
Summary
Competent billing professional with 19 years of experience. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating company values through impeccable work ethic and drive. Experience in handling a wide variety of medical billing tasks, including; billing primary, secondary and tertiary insurances. Experience with handling insurance denials in a timely maner. Determined and hardworking individual with excellent communication skills and multitasking abilities. Revised billing policies and procedures for client billing to ensure timely and efficient billing. Worked closely with hospital CFO's and contracts grow our client billing accounts. Experience with account audits such as nurse and LifeSharing audits. Managed and maintained LifeSharing accounts to ensure accurate billing of such accounts.
Overview
19
19
years of professional experience
Work History
Medical Billing Specialist
Sharp Healthcare
01.2005 - Current
- Responsible for billing facility claims to correct insurance within timely filing guidelines, correct any errors on claims before submitting, and add coding modifiers when needed.
- Responsible for billing client accounts per individual client contracts.
- Maintain insurance and client work ques work insurance correspondence, EOB's and denials in timely fashion.
- Contact insurance to review, appeal and or check on status of claims if unable to locate in provider portals.
- Precisely evaluated and verified benefits and eligibility.
- Identified and resolved client billing and payment issues.
- Prepared billing correspondence and maintained database to organize billing information.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Verified accuracy of accounts payable payments, resulting in reductions in payment errors and check reissues.
- Used data entry skills to accurately document and input statements.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Conducted regular audits of client accounts for potential underpayments or overpayments due to incorrect coding or billing practices.
- Collaborated closely with the finance teams to ensure proper documentation was obtained for accurate billing purposes.
- Kept vendor files accurate and up-to-date to expedite payment processing.
- Coordinated with other departments to address any discrepancies or concerns related to charge capture or data entry accuracy.
- Maintained accurate records of customer payments.
- Participated in departmental meetings, sharing insights and ideas for improving overall medical billing efficiency and revenue generation.
- Collaborated with clients to resolve disputes.
- Provided exceptional customer service to both patients and client representatives, resolving inquiries quickly and professionally.
- Delivered timely and accurate charge submissions.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Generated monthly billing and posting reports for management review.
- Maintained strong working relationships with healthcare providers, fostering clear communication regarding billing-related matters.
- Efficiently processed refunds or adjustments for patients when necessary, ensuring accuracy and compliance with company policies.
- Streamlined billing processes by implementing efficient workflows and utilizing advanced software tools.
- Monitored outstanding invoices and performed collections duties.
- Posted payments and collections on regular basis.
- Posted and adjusted payments from clients.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
- Produced and mailed monthly statements to clients and assisted with related requests for information and clarification.
- Paid attention to detail while completing assignments.
- Proven ability to learn quickly and adapt to new situations.
- Proven ability to develop and implement creative solutions to complex problems.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Worked effectively in fast-paced environments.
- Cultivated interpersonal skills by building positive relationships with others.
- Demonstrated creativity and resourcefulness through the development of innovative solutions.
- Identified issues, analyzed information and provided solutions to problems.
- Developed and maintained courteous and effective working relationships.
- Applied effective time management techniques to meet tight deadlines.
- Resolved problems, improved operations and provided exceptional service.
- Worked well in a team setting, providing support and guidance.
- Skilled at working independently and collaboratively in a team environment.
- Passionate about learning and committed to continual improvement.
- Proved successful working within tight deadlines and a fast-paced environment.
- Excellent communication skills, both verbal and written.
- Provided professional services and support in a dynamic work environment.
Education
Medical Billing & Coding
Maric College
San Diego, CA01.2005
High School Diploma -
Mira Mesa High School
San Diego, CA06.1985
Skills
- ICD-10, CPT/HCPCS knowledge
- Medical terminology
- MS Office
- Able to work Remotely
- Medical Records Management
- Insurance Knowledge
- HIPAA Compliance
- Invoice Processing
- Patient Care
Accomplishments
2017 C.O.R.E. Award Winner in finance for development of purchased services from Radys Childrens Hospital.
Timeline
Medical Billing Specialist
Sharp Healthcare
01.2005 - Current
Medical Billing & Coding
Maric College
High School Diploma -
Mira Mesa High School
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