Shoni Preston
Houston,TX
Summary
Diligent professional versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines.
Overview
10
10
years of professional experience
Work History
Underpayment Analyst
Parallon
02.2020 - Current
- Interpret and analyze contracts to ensure accounts are being reimbursed correctly.
- Identify underpayments by checking payments received against the contracted fee schedule.
- Analyze EOB denials and determine necessary steps to correct claims.
- Responsible for validating appeal opportunities, creating appeal letters, tracking appeals and recoveries.
- Adhere to productivity requirements of 25-30 accounts per day.
Billing Specialist
Veterans Evaluation Services
12.2018 - 02.2020
- Adjudicated and processed payment and denial of all types of claims.
- Corrected claims payment or denials.
- Resolved adjudicated claims for allocations of deductibles, co-pays, co-insurance maximums and provider reimbursements.
- Reported over/ under payments and other irregularities with medical claims.
- Achieved and maintained daily productivity of 100-150 claims per day.
Reimbursement Specialist
Primesource RX
10.2017 - 11.2018
- Responsible for accurate and complete data entry, investigating and submitting claim benefits including the prior authorization process.
- Conducted initial level medication prior authorization, exception, and medical necessity submitted to the plan to determine coverage under the members benefit.
- Prevented delays and claim denials by correcting information prior to submission.
- Ran test claims and resolved NCPDP rejections.
- Ensure timely adjudication of prescription claims through PBM systems.
Client Billing Specialist
Sonic Healthcare
03.2017 - 10.2017
- Analyzed client completed CPL service requisition forms, determined appropriate charge category, and transcribed pertinent data into Patient-Maintenance on-line database.
- Paid or denied claims based upon established claims processing criteria.
- Interpret ICD-9 & 10, and CPT coding for proper processing of claims.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Monitored claims processing trends to identify potential areas of improvement.
Claims Analyst
Ascension
08.2013 - 03.2017
- Analyzed, researched, and processed insurance claims through electronic management systems.
- Reviewed and processed complex/ non- complex provider payment appeals.
- Ensured accurate and complete claim submission for bother paper and electronic claims.
- Evaluated electronic insurance rejections in order to retransmit with corrected claim information.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Education
High School Diploma -
Del Valle High School
Del Valle, TX05.2004
Skills
- Analytical Thinking
- Compliance Analysis
- ICD-9 & 10
- Medical Software
- AthenaHealth
- QNXT
- Cerner
- AMISYS
- Facets
- NextGen
- UB04 and 1500 billing
- Prior Authorization
- Microsoft office/ Excel
- Physician based and Hospital based billing
- Health Insurance (Commercial, Government, and Managed care)
- Medical Terms and Procedure Knowledge
- Insurance Claims Processing
- Healthcare Billing Knowledge
- Medical Terminology Familiarity
- HIPAA Compliance Awareness
- Claim Denial Resolution
Timeline
Underpayment Analyst
Parallon
02.2020 - Current
Billing Specialist
Veterans Evaluation Services
12.2018 - 02.2020
Reimbursement Specialist
Primesource RX
10.2017 - 11.2018
Client Billing Specialist
Sonic Healthcare
03.2017 - 10.2017
Claims Analyst
Ascension
08.2013 - 03.2017
High School Diploma -
Del Valle High School
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