Tahn Sims
Garland,TX
Overview
18
18
years of professional experience
Work History
EDI Specialist
National Partners in Healthcare
Dallas, TX
04.2022 - Current
- Manage an inventory of rejected claims in the clearinghouse to provide resolution for claim submission.
- Call the insurance company to check eligibility and obtain claim information for processing.
- Plans and conducts investigation of claims to confirm coverage using available resources such as Availity and/or Instamed.
- Work tasking requests from other departments within the company. For example completing claim rebills from Charge Entry.
- Use Coverage Detection tool in Waystar/ Zirmed Clearinghouse to look for active insurance coverage.
- Analyze and review trending claim rejections within the Clearinghouse to provide resolution.
- Utilized insurance provider portals to check eligibility as well as claim status.
Implementation Analyst
National Partners in Healthcare
Dallas, TX
03.2019 - 04.2022
- Completed ticket requests from Accounts Receivable regarding insurance, provider, and facility loads.
- Assisted the provider enrollment department in updating and/or maintaining current information for new and present providers regarding system loads.
- Provided training to new hires as well as refresher training to current employees.
- Electronically uploaded charges daily from the charge entry department.
- Processed proposals from various insurance companies.
- Notified Billing Manager regarding trends and or errors from the EDI rejections.
- Post payments manually from EOBS as well as electronic payment posting.
- Provided additional assistance for the charge entry and demographics dept to help with month-end closing.
- Facilitated in the gathering of information for internal and external audits.
- Contributed to maintaining system load requests from a ticketing software.
- Provided additional assistance for EDI when processing claim edits from the Waystar clearinghouse.
Charge Entry Team Lead-Supervisor
US Anesthesia Partners
Dallas, TX
04.2008 - 03.2019
- Supervised 8-10 billers posting charges for over 1700 Anesthesiologists and CRNA.
- Researched and resolved inquiries regarding all billing and patient account discrepancies and verified that all adjustments were correct.
- Prepare all charge tickets to be posted the next business day for all billers by hospital and location.
- Prepared monthly audits for quarterly bonuses for all charge entry specialists.
- Updated and monitor spreadsheets regarding the monthly distribution of work and productivity.
- Assisted the manager with any corrections that need to be done for other departments.
- Posted charges and demographics when needed.
- Trained new hires for charge entry.
Account Receivable Specialist
US Anesthesia Partners
Dallas, TX
04.2008 - 03.2019
- Audit and monitor patient accounts for further payment and/or adjustments.
- Resolved outstanding balances through consistent follow-ups and appeals to third-party insurance payers Work all correspondence daily and appeals in a timely manner.
- Performed the necessary research to correct and resubmit all HCFA 1500 claims as needed.
Timeline
EDI Specialist
National Partners in Healthcare
04.2022 - Current
Implementation Analyst
National Partners in Healthcare
03.2019 - 04.2022
Charge Entry Team Lead-Supervisor
US Anesthesia Partners
04.2008 - 03.2019
Account Receivable Specialist
US Anesthesia Partners
04.2008 - 03.2019