Takira Appleberry
Fairburn,GA
Summary
I am a motivated and detail-oriented professional with over 10 years of experience in healthcare administration, claims processing, billing, and credentialing. I am skilled in managing high-volume tasks with accuracy and professionalism. Strong communicator with a commitment to efficiency, team success, and continuous growth. Seeking to contribute to a dynamic organization.
Overview
12
12
years of professional experience
Work History
Credentialing Specialist
IDR
Alpharetta, GA
10.2024 - 05.2025
- Screen provider enrollment packages for missing information and request missing information from provider.
- Work various workflow queues for provider information.
- Make outbound Calls and emails to provider for missing information.
- Plan, prioritize, organize and complete work to meet established objectives, review CAQH, Contracting for office locations.
- Collect, review and verify dental providers’ credentials, including education, training, licensure, certifications, and work history, review credentialing applications for various states.
- Maintain detailed and accurate records of email and call interactions in system database.
Billing Specialist/ Charge Poster
Southern Cresent Woman Healthcare
Fayetteville, GA
09.2023 - 12.2023
- Accurately input charges into the system to ensure error-free billing processes, safeguard sensitive information and maintain trust.
- Implemented effective strategies to streamline accounts receivable management and maximize collections.
- Promptly resolved rejections and denials of claims, reducing delays and maximizing revenue flow. Proficient in ICD-9 and ICD-10 coding systems.
- Maintained transparent and accurate records of all accounts and outstanding balances, guaranteeing data integrity.
Claims Analyst (Hybrid)
Blackhawk Claims
Irving, TX
09.2022 - 06.2023
- Processed supplemental medical and dental insurance claims accurately and efficiently.
- Conducted research and evaluations of various insurance policies to ensure optimal coverage for clients.
- Oversaw billing and coding assignments, deciding whether to approve or reject payments.
- Recorded transactions, calculated monthly contractual allowances, and examined budget discrepancies to enhance financial management.
- Utilized claims management systems to document, track and update claim status.
Case Manger (Remote)
Remx Temp/ Mckesson
Irving, TX
11.2021 - 03.2022
- Streamlined medical processes by organizing patient cases for Cosenytx.
- Expedited prior authorizations and insurance verifications to assist patients promptly.
- Delivered responsive telephone assistance, managing both incoming and outgoing calls.
- Collaborated with interdisciplinary healthcare teams to optimize patient care and outcomes.
- Demonstrated perseverance, empathy, and commitment to the autonomy and well-being of patients in every case.
- Processed claims, verified claim information, including supporting documentation, to determine eligibility and coverage.
HR Manager/ Recruiting Specialist
Brightstar Care/ Millbrooke Inc
Springfield, IL
08.2020 - 11.2020
- Generating Hiring onboarding paperwork, creating badges and orientating new hires.
- Run background checks, Recruiting, interviewing and hiring new staffs.
- Drug screening, Create employee files on company database.
- Completing I-9s, performance management, training new hires and keeping all employees in compliance with yearly training.
Patient Service Representative ( Registar)
HSHS Medical Group
Springfield, IL
12.2019 - 08.2020
- Answering incoming calls for patients, scheduling/ canceling appointments, and transferring incoming calls to multiple Dr. Offices.
- Registering new patients and sending encounters to nurses on behalf of patient’s pharmacy inquiries.
- Transferring patient’s accounts and balancing credits and overpayments.
- Biling different insurance companies and Medicare recipients.
- Adjusting claims and posting payment to accounts.
Customer Service Representative
Horace Mann Service Corporation
Springfield, IL
09.2018 - 12.2019
- Answering incoming calls from clients for life and annuity insurance.
- Accessing annuity accounts and client’s personal information.
- Chat/email customers through an online account portal and identify and resolve current and potential billing errors.
- Process payments for life and annuity accounts, ability to research and investigate billing errors.
Customer Advocate II/ Claims Examiner- Remote
HCSC/ Blue Cross Blue Shield
Springfield, IL
08.2013 - 07.2018
- Answering incoming calls from providers and nurses regarding claims denials, medical and dental benefit coverage.
- Adjusting and researching denial of claims.
- Creating EOBS, verifying medical coverage and reviewing medical records.
- Calling other insurance companies to verify COB, generating denial letters of claims.
- Sending inquiries to other insurance companies on behalf of providers, processing medical claims.
Education
Complete Coursework towards Nursing Degree -
Lincoln Land Community College
01.2020
Certified Nursing Assistant -
New Start
06-2006
Highschool Diploma -
Southeast High School
01.2003
Skills
- Data analytics
- Records search
- Legal writing
- Excellent communication
- Organized
- Microsoft Office Suite
- Data Entry
- 10 Key
- HCPS/ ICD 10
- Epic
- Certified Nursing Assistant
- BLS
Timeline
Credentialing Specialist
IDR
10.2024 - 05.2025
Billing Specialist/ Charge Poster
Southern Cresent Woman Healthcare
09.2023 - 12.2023
Claims Analyst (Hybrid)
Blackhawk Claims
09.2022 - 06.2023
Case Manger (Remote)
Remx Temp/ Mckesson
11.2021 - 03.2022
HR Manager/ Recruiting Specialist
Brightstar Care/ Millbrooke Inc
08.2020 - 11.2020
Patient Service Representative ( Registar)
HSHS Medical Group
12.2019 - 08.2020
Customer Service Representative
Horace Mann Service Corporation
09.2018 - 12.2019
Customer Advocate II/ Claims Examiner- Remote
HCSC/ Blue Cross Blue Shield
08.2013 - 07.2018
Complete Coursework towards Nursing Degree -
Lincoln Land Community College
Highschool Diploma -
Southeast High School
Certified Nursing Assistant -
New Start
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