Customer Service Medical Billing
Resume:
Shaundria Borders
*** **** ***** ***** *******, GA 30228 678-***-**** acdsnq@r.postjobfree.com
Dear Hiring Personnel:
I believe I am the perfect fit for the position available with your company. I am highly qualified to work
for you not only because of my educational background, but also because I have gained valuable
experience.
The key strengths I possess for success in this position include, but are not limited to:
• Degreed and Certified Member of AAPC, and ACSM
• Experience in Medical Billing & Coding
• Experience overseeing and training
• Extensive knowledge of Government and Commercial Payers
• Experience handling claims through entire revenue cycle
• Experience working in clinical and non-clinical setting
You will find me to be well-spoken, energetic, confident, and personable. I also have a wide breadth of
experience that gives me the versatility to be placed in a number of roles with confidence that the level of
excellence you expect will be met. Please see my resume for additional information on my experience.
Thank you for your time and consideration.
Sincerely,
Shaundria Borders
SHAUNDRIA BORDERS
956 Fire Thorn Drive Hampton, GA 30228 678-***-**** acdsnq@r.postjobfree.com
COMPETENCY
Problem Solving – Capable of identifying and resolving problems in a timely manner; knack for gathering
and analyzing information skillfully.
Customer Service – Experienced in managing difficult situations with a prompt response to the needs and
immediate attention.
Oral Communication – Articulate speech accompanied with a positive attitude, and great listening skills to
respond well to questions.
RELEVANT EXPERIENCE
Broad-Path Health Solutions, Remote 09/2012-Current
Medical Call Center Agent/Customer Service Representative III
• Work flexible schedule from home as a blended agent taking inbound calls and making outbound calls to
assist existing members, prospective members, providers and brokers with benefit plan options and inquiries.
• WAH experience using a thin-client system, worked automated dialing system contacting and performing
survey assessments to health plan participants with an aggressive time for completion.
• Resolve customer service inquiries on the phone with regards to medical benefits, eligibility and claims,
referrals and authorizations, primary care physician selections, and pharmacy benefits.
• Respond swiftly to written correspondence requests about premiums, enrollment/disenrollment and
miscellaneous issues.
• Resolve outstanding disputes on behalf of the plan in real time or through comprehensive and timely follow-
up.
• Use listening skills and knowledge to identify customer need and appropriate issue resolution while
maintaining time management skills to ensure efficiency.
• Research complex issues across multiple databases and work with support resources to resolve member
issues.
• Repaneled physicians for the health plan to include member enrolled in Medicare, Medicare Advantage,
Medicaid, and the commercial policies.
• Troubleshoot computer issues as it relates to maintaining network connectivity.
• Proficient in OB Dialer, Automated Dialer, Dialsource, Telephony inbound/outbound: Contactual
• System and Equipment: Salesforce-CTI integration with the five-9 (Virtual Call Center (VCC) operating
system
• Communications: Outlook 365 Suite including Lync, Jabber Headset, Company Supplied Lap Top, Current
projects completed – Lovelace Health Plans, Cambia Regence BCBS
• Performance was measured with a specific set of call handling metrics (ACW) Avg <5 % and quality scores
of 4.0 or greater.
Cardiovascular Group, P.C. 10/2009-09/2012
Medical Billing Analyst
• Travel to neighboring hospital’s our physicians contracted with to obtain medical records, review each record
for accurate reporting, assign CPT, HCPCS II, and ICD-9 codes to in office and outpatient hospital procedures to
accurately reflect services rendered
• Ensure claims are properly adjudicated and paid by reviewing all claims prior to transmission, investigating
claim denials, appealing unpaid claims, ensuring requested documentation related to claims are submitted in a
timely manner, and identifying problems and trends to prevent future billing errors
• Prepare A/R reports for all billers, and train newly hired employees on policy/procedure and supervise timely
completion of the A/R report
• Make certain payments made by the primary payer are based on contracted fee schedule and in accordance to
the terms and agreements of the policyholder.
• Monitor and analyze significant legal developments and legislative changes in service territories that may
impact claim operations; communicates conclusions and recommendations to the appropriate parties.
• Attend morning meetings to discuss projects and assignments, plan strategies, and suggest improvements.
• Maintain a direct relationship with all provider representatives and remain up to date on all insurance
changes/updates to our provider contact.
• Monitor unbilled accounts and contact the appropriate party (referral department/neighboring hospitals) to
ensure authorization is obtain for services rendered
• Remain up to date on all insurance websites (such as Cahaba. CMS, and MMIS) and appeal procedures
Physical Therapy in Motion, McDonough, GA 01/2006 -03/2009
Front Office Administrator / Clinical Exercise Specialist
• Answer patient inquiries and resolve issues with regards to scheduling, insurance, verifications, referrals,
prescriptions, device orders, and special request.
• Make outbound calls in regards to appointment request from PCP, patient follow-up, payment plans, and
ongoing exercise prescriptions.
• Obtain records, incident notes and clinical documentation needed for billing purposes.
• Manage patient accounts and obtain payments from each patient at point of service.
• Verify insurance, collect payments, create claims, and ensure payment is received.
• Assign appropriate CPT, HCPCS II, ICD-9 code(s) to accurately report services rendered
• Analyze and resolve physician claim rejects and denials
• Identifies trends/problems in medical documentation and recommend possible solutions.
• Review and report on any changes for follow up visit.
• Attend morning meetings to discuss projects and assignments, plan strategies, and suggest improvements.
• Work with patients in the clinical setting, based on Physical Therapist instruction, to fulfill exercise
prescription
Piedmont Fayette’s Cardiac Rehabilitation Center, Fayetteville, GA 05/2008 - 08/2008
Exercise Physiology Intern
• Assess patient’s understanding and knowledge of relevant information relating to health, prevention,
cardiovascular risk factors, disease, chronic illness, physical activity, basic dietary practice, and other relevant
information before, during and after completion of exercise session
• Conduct evaluation and prescribe exercise programs for overall health maintenance
• Conduct group classes according the guidelines set down by American College of Sports Medicine while
providing modifications for special populations
• Monitor and assess cardiovascular and metabolic effects and mechanisms of exercise to adjust exercise
prescription.
• Conduct educational sessions with phase II patients on topics such as diabetes awareness, importance of
dietary considerations, and the positive effects of exercise on the cardiorespiratory system
• Observe surgical procedures for phase I patients (such as cardiac bypass) to increase procedural
understanding
EDUCATION: Clayton State University, Bachelor of Science Degree 2008/ GPA 3.4
Certifications: AAPC Certified Professional Coder (CPC) – 01292397, Clinical Exercise Specialist through
ACSM- 1008390, CPR Certification through AHA, certificate of First Aid through American Red Cross
Relevant Coursework: Principles of Accounting, Legal issues in Healthcare, Health in Corporate Settings, Cultural
Diversity in Healthcare, Ethical Issues in Healthcare, Marketing in Healthcare, Applied HR Management in Healthcare
Delivery, Healthcare Finance, Healthcare Environments, Anatomy & Physiology I & II, Human Growth and
Development, Clinical Pharmacology, Microbiology for Health Science
Professional References
Melanie Poudevigne, PhD
Clayton State University Program Director/Associate Professor
2000 Clayton State Blvd
Morrow, GA 30260
acdsnq@r.postjobfree.com
Coy Leverette III, MPT
Owner/Director Physical Therapy in Motion
106 Vinings Drive
McDonough, GA 30253
acdsnq@r.postjobfree.com
Candace Damon
Cardiovascular Group Manager
755 Walther Road
Lawrenceville, GA 30045
acdsnq@r.postjobfree.com
Alice Moran Tilles
Piedmont Fayette Cardiac Rehabilitation Exercise Physiologist
1255 Highway 54 West
Fayetteville, GA 30214
acdsnq@r.postjobfree.com
Contact this candidate