Shanda Thomas

*** ***** **** ******, ******** CA, 94804 510-***-**** acssqn@r.postjobfree.com

SUMMARY OF QUALIFICATIONS

* ***** ** ********* ******* assistance, and administrative support to management, contract coordinators and contract representatives, Received an “Appreciation” Award. Proven ability to communicate with people on all levels. Expect at prioritizing assignments, ongoing daily deadlines.

Proven ability to prioritize assignment and special projects with excellent verbal and written skills.

7 years of account receivables/collections, and follow-up on insurance companies, such as Aetna, Anthem Blue cross/Blue Shield, Cigna, The Hartford, Health net, Medicare/Medi-cal, Mutual Advantage, Untied Healthcare Group and patients. Coordinated with varies medical departments for documentation, authorizations and referrals for direct resubmission of denied claims. Provided customer service for members dealing with insurance complex issues. Knowledge in Durable Medical Equipment and Medicare, CMS claim forms. Research claims/bills for appropriate groups and support documentations.

2 years of processing refunds to insurance companies and patients, using daily payment posting, and adjustment logs. Reviews overpayment, underpayments and other irregularities.

Level of Proficiency IBM PC Compatible, DEC Mainframe, 10 key by touch, typing 45 wpm

(Microsoft Word, Excel, PowerPoint, Access, Outlook) Verifyit 5.0, Adobe Acrobat, Word Perfect, EPIC Cash Flow Management, Medical Manager, MD Portal and Care Pad Encoder.

PROFESSIONAL EXPERIENCE

Recruiting Solution Incorporated, San Mateo, CA

The State Bar of California, San Francisco, CA July 2015-Present

Administrative Assistant I (Contracted Position)

Arranged attorney’s certifications by date order for auditing team to process.

Assisted in processing paperwork for auditing attorneys selected to complete the Minimum Continuing Legal Education (MCLE).

Maintain deficiency files that does not meet State Bar rules and regulations.

Oversee massive documentation thru emails and standard mail received.

Processed late submission penalty fees received from attorneys.

Appleone, Santa Rosa, CA April 2015 - Present

Gilardi & Co LLC San Rafael, CA

Intake Associate l /Verifier (Contracted Position)

Open and review high volume of claims that are associated with Class Action Suits.

Check all appropriate documentation per required from claimants to process according.

Number and prepare for subsequent scanning and analysis.

Responsible in verifying claims for errors using verifyit 5.0 system.

Health Net of California, Oakland, CA Aug 2007 – Mar 2014

Provider Network Assistant

Enter provider self-nominations, and assist in general provider contract preparations for massive monthly mailing, faxing and scanning of contracts to providers.

Provided technical and administrative support to Contract Negotiation Representative.

Processed and mailed clients welcome packet materials, using NTCS (National Contract Tracking Systems).

Prepare contracts for storage, using NARA (National Archive Record Administrative System), Utilizing Iron Mountain Storage facility to maintain security.

Provided research to vendors, member problems, questions and complaints.

Analyze and adjust data and benefits criteria for payment.

Responsible for assuring that all providers information, demographics, fee key, and rates are in place and ready to be processed.

Effectively monitored group members sent to PDM (Provider Department Management), using NTCS system.

Achieved in completing all training that is assigned under the HIPPA/PHI rules and relegations.

Earned high marks on performance evaluations for excellence in provider assistance/administrative support within Direct Network Department.

Office Team Healthcare, San Francisco, CA Jan 2007 – May 2007

Medical Billing Specialist (Contracted Position)

Responsible for billing of a large Specialty Surgical Practice, which consist of multiple surgeons

(Bay Area Surgical Specialist).

Proficiency in data entry billing codes, insurance follow-up and collections efforts on PPO, HMO and

Government Insurance/patient follow-up, payment posting and filing claims electronically.

Experience in verifying eligibility, entering insurance information, and patient demographics.

Understanding of Medical Terminology, ICD-9/CPT-4 /HCFA 1500 and UB04 claim forms.

Nelson Staffing, San Rafael, CA Jan 2006 – Jan 2007

Claims Reviewer/Office Assistant/Customer Service/Charge Processor (Contracted Position)

Responsible for direct submission of claims from clients, that were coded incorrectly and denied for untimely filing.

Provided customer service for members which experienced denied, and problem claims.

Quality assurance on reviewing claims for accurate payment, identifying problems and correct as appropriate.

Provided administrative support, and implement solutions based on information from external sources and clients.

Processed, and coded charges for varies doctors assigned to California Pacific Medical Center.

Other duties as assigned.

Anesthesiologist Associated, Inc. Walnut Creek Jan 2005 – Jan 2006

Payment Analyst

Received audit instructions, code, and post payments and credit card payments to physician accounts.

Conduct follow-up as needed on accounts including rebilling, filing appeals, billing secondary and supplemental insurance.

Communicate with payers, members to resolve issues/appeals on discrepancy accounts.

Calculate and post adjustments per contracts terms.

On Assignment Staffing, Oakland, CA Aug 2002 – Dec 2004

Medical Biller/East Bay Prenatal (Contracted Position)

In-charge of posting/entering all physicians charges, of data entry on system using Perfect Practice.

Responsible for preparation of new patient charts, including adding the appropriate forms,

Documents and medical records check eligibility, benefits and authorizations.

Maintained complex scheduling for patient’s appointments to see healthcare educators.

Other duties as assigned.

Marin General Hospital, Greenbrae, CA June 2001- Aug 2002

Cash Receipt/Credit Balance Clerk

Responsible for authorizing and processing of refunds to insurance companies and patients.

Reviewed errors in chargers, adjustments and payments, which accumulated a high volume of refunds.

Provided assistance to the Payment Posting Department when help is needed.

Responsible for daily balancing of payments received and posted each day.

I n-charge of all insurance, and patient corresponds request for refunds, which requires keeping a log that needs to be completed each month end of business day.

EDUCATION

Diploma El Cerrito High School, El Cerrito CA

Diploma in Business Management, South West Business College, San Francisco, CA

Business Administration Contra Costa College, San Pablo, CA

COMMUNITY INVOLVEMENT

Providence Baptist Church-Outreach/Ministry, Richmond, CA

RPAL (Richmond Police Activities League) Richmond, CA

Shanda Thomas -2 -

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