Tamara Shaffer
Fillmore,IN
Summary
Detailed Oriented individual with 13 years working in Revenue Cycle Management. My experience includes claim follow-up, understanding EOB's, denials, appeals, eligibility, updating insurance coverages, resubmission of claims, recoups, coordination of benefits, provider portals, claim edits/rejects, combining accounts to prevent overlap or due to Medicare payer regulations. Experienced working Government (Medicare & Medicaid), Commercial, Managed Care, Workers Compensation, and Third-Party Liability claims. EPIC experience includes both Physician Billing & Hospital Billing. I most always receive 100% on my EPIC quality scorecards. (Monthly Random Quality Checks) I am interested in finding a new remote opportunity to work from home. I have been working 100% remotely since March of 2020.
Overview
14
14
years of professional experience
Work History
A/R Collection Specialist
Impact Advisors (via Tandym Group)
02.2025 - 04.2026
- Supporting Christus Health, Sharp Healthcare, and University Hospital.
- Performed end to end A/R management, collections, account follow-up, denial resolution, and appeals for clients in California, Texas, and Ohio.
- Manage full lifecycle denials and appeals including root-cause identification, drafting appeal letters, resubmitting corrected claims and driving claims to final resolution.
- Utilized EPIC PB and EPIC HB to work claims, manage work queues, resolve claim edits, perform follow-up, and support follow-up and support billing/revenue integrity workflows.
- Experienced in life cycle billing processes, including initial claim submission, claim edits, resubmissions with coordination with billing and revenue teams.
- Strong background in Commercial and Government payer collections including manage care plans, IPA's, and state specific requirements (California, Texas, and Ohio).
- Conducted inpatient/hospital collections with a accuracy and efficiency resolving claim edits and reimbursement issues.
- Consistently clearing 40 to 65+ accounts per day.
- Demonstrated strong customer service with clear communication to payers, internal teams, and clients.
- Systems used: EPIC, Citrix, Microsoft Office, Outlook, Word, Excel etc.
BILLING SPECIALIST II
Community Health Systems
09.2024 - 12.2024
- Review daily rejects reports from the EDI billing system and make necessary corrections to allow electronic submission.
- Daily follow up on outstanding requests sent to facilities to review requested documentation needed to correct reason for reject.
- Review insurance information and find updated active insurance. Verify eligibility via online provider portals (WPS, Availity, Passport aka One Source, Alabama & Texas Medicaid, etc.)
- Systems used: Artiva, SSI, Citrix, Cerner etc.
- Responsibilities in this Billing Specialist at Community Health Systems same as previous Billing Specialist position at Franciscan Alliance.
MEDICARE BILLING SPECIALIST
Franciscan Alliance Hospital
10.2023 - 06.2024
- Review daily edit reports for overlapping charges to combine accounts or transfer overlapping charges.
- Review daily edits from Experian billing system to make necessary corrections to allow automatic resubmission.
- Review daily edits (work ques) to identify reason for claim stopping prior to submission. Make necessary corrections such as adding Medicare components, updating primary EOB information, updating type of bill, adding ICN/DCN numbers, updating value codes and remarks, adding missing information, routing to proper work que for further review.
- Review denied claims due to expenses occurred after policy termed. Review coverage, eligibility, coordination of benefits to submit claim to next payer (Commercial, Medicare, Medicare Replacement, MMAI, Medicaid).
- Review EOBs of all payers to verify next payer or patient responsibility.
- Reviewing Medicare WPS, NGS, FISS, Medicaid, OneSource, Availity etc. portals to review eligibility and claim status.
COLLECTIONS SPECIALIST, NON-GOV DEPT.
Franciscan Alliance-Franciscan Physician Network
04.2021 - 10.2023
- Review aging claims in assigned work ques in a timely manner. Although I worked in Non-Gov Dept., worked secondary or tertiary payers Medicare & Medicaid.
- Familiar with Medicare, Medicare Supplement, Medicare Replacement& MMAI, State Medicaid & Commercial Medicaid (Healthy Indiana Plan issued by Anthem BCBS etc.)
- Outgoing phone calls and/or reviewing online payer portals to status claim.
- Document status of medical claims and any actions taken in account notes.
- Prepare reconsideration letters submitting medical records due to claim denial.
CREDIT REFUND SPECIALIST, CASH DEPT.
Franciscan Alliance-Franciscan Physician Network
08.2018 - 04.2021
- Reviewing assigned work ques for accounts with credit balances normally due to multiple payments received from different payers.
- Review EOBs of payers, (Commercial, Workers Compensation, TPL, Medicare, & Medicaid including patient registration for review of coordination of benefits to determine the correct payer. Also reviewed medical records to verify type of injury for workers compensation & verify injuries from MVA for TPL claims.
- Requesting recoupment by completing online forms and providing documentation to support recoup request.
- Document all recoup requests and all actions taken in account notes.
- Auditing recoup request documents prepared by co-workers to verify accuracy prior to submission of recoup request.
CUSTOMER SERVICE REP II, MEDICARE SUPPLEMENT
Anthem BCBS
01.2013 - 08.2018
- Call Center - Answering phone calls.
- Provider & Member written correspondence via Availity online secured messaging. Provider inquiries include questions about denied claims. Member inquiries include questions about benefits & claims.
- Auditing Power of Attorney & HIPAA authorization forms. Approved and loaded forms in system so that callers can be verified to receive PHI (Protected health information).
- Claims, Benefits, Eligibility, Denials, Status of appeals & Medical record requests.
- Knowledge of Medicare Supplement Plans A - N, Medicare Replacement Plans, Commercial Group Plans, Individual Plans.
- Systems: EPIC, Facets, Citrix, FISS, Mainframes, Microsoft Office, Word, Excel, Microsoft Outlook, Right Fax, Online Portals: Availity, OneSource, WPS, & NGS.
FRONT OFFICE SPECIALIST, TEMPORARY INTERN POSITION
Southside OBGYN
08.2012 - 10.2012
- Supporting Christus Health, Sharp Healthcare, and University Hospital.
- Performed end to end A/R management, collections, account follow-up, denial resolution, and appeals for clients in California, Texas, and Ohio.
- Manage full lifecycle denials and appeals including root-cause identification, drafting appeal letters, resubmitting corrected claims and driving claims to final resolution.
- Utilized EPIC PB and EPIC HB to work claims, manage work queues, resolve claim edits, perform follow-up, and support follow-up and support billing/revenue integrity workflows.
- Experienced in life cycle billing processes, including initial claim submission, claim edits, resubmissions with coordination with billing and revenue teams.
- Strong background in Commercial and Government payer collections including manage care plans, IPA's, and state specific requirements (California, Texas, and Ohio).
- Conducted inpatient/hospital collections with a accuracy and efficiency resolving claim edits and reimbursement issues.
- Consistently clearing 40 to 65+ accounts per day.
- Demonstrated strong customer service with clear communication to payers, internal teams, and clients.
- Systems used: EPIC, Citrix, Microsoft Office, Outlook, Word, Excel etc.
Education
Diploma - Medical Office Specialist
Kaplan College
Indianapolis, IN10.2012
Skills
- Proficiency in quality
- Claim Denials
- Decision Making
- Computer Proficient
- Detailed-Oriented
- Active Listening
- Understanding EOB's
- EPIC PB & HB Experience
- Reconsiderations/Appeals
- Eligibility/Registration
Timeline
A/R Collection Specialist
Impact Advisors (via Tandym Group)
02.2025 - 04.2026
BILLING SPECIALIST II
Community Health Systems
09.2024 - 12.2024
MEDICARE BILLING SPECIALIST
Franciscan Alliance Hospital
10.2023 - 06.2024
COLLECTIONS SPECIALIST, NON-GOV DEPT.
Franciscan Alliance-Franciscan Physician Network
04.2021 - 10.2023
CREDIT REFUND SPECIALIST, CASH DEPT.
Franciscan Alliance-Franciscan Physician Network
08.2018 - 04.2021
CUSTOMER SERVICE REP II, MEDICARE SUPPLEMENT
Anthem BCBS
01.2013 - 08.2018
FRONT OFFICE SPECIALIST, TEMPORARY INTERN POSITION
Southside OBGYN
08.2012 - 10.2012
Diploma - Medical Office Specialist
Kaplan College