Medical Insurance
Resume:
SHELIA R. DeLOACH
Jacksonville, FL 32225
********@*******.***
HEALTH AND HUMAN SERVICES PROFESSIONAL
Government Contracts • Billing • Public & Provider Relations • Regulatory Compliance
PROFESSIONAL SKILLS
Proficient in Microsoft Office Communication, Presentation & Facilitation
Customer Relations Management Critical Thinking & Problem Solving
Strategic & Project Management Quantitative & Qualitative Analysis
Financial & Resource Management Process Improvement & Research
Data & Documentation Management Claims & Benefit Administration
PROFESSIONAL EXPERIENCE
1997-Present Agency for Health Care Administration, Human Srvc Program Specialist
1995-1997 Billing Specialist Team Leader, Medaphis Corporation
1994-1995 Financial Case Manager, Baptist Beaches Medical Center
1991-1993 ER Registrar, Tri-City Medical Center
1990-1991 Financial Counselor, Family Care Center
1989-1990 Medicaid Billing Specialist, Vanderbilt Medical Center
PROFESSIONAL PRESENTATIONS & PUBLICATIONS
Agency for Health Care Administration
Medicaid Beneficiary Outreach Team, Educator
Medicaid Messages, Quarterly Publication • Authored statewide articles for members on
Men’s Health, Adult Immunizations and Medicaid Reform
MediPass Newsletter, Quarterly Publication • Authored articles for Providers in (7)
counties on Provider Authorizations, Eligibility, Verifications, Co-Payments, Enrollment
Schedules, Policy Changes & Updates that impact quality of care
EDUCATION
Bachelor of Science Degree, Health Science with emphasis in Community Health,
Memphis State University, Memphis, TN
Studied Health Science, Masters of Science Degree Program, University of North
Florida, Jacksonville, FL
Studied General Education, Jackson State Community College, Jackson, TN
S. DeLoach Page 2
PROFESSIONAL PROFILE
HUMAN SERVICES
Demonstrate a working knowledge of the organization’s structure, products and
services
Explain the Florida Medicaid Program; its services and benefits to members
Serve as a liaison and provide technical assistance to providers, recipients and federal,
state and community agencies
Receive, investigate and respond to routine or complex telephone and face-to-face
inquires, complaints and billing issues
Conduct training classes and attend statewide training classes or conference calls on
newly implemented Florida Medicaid policy changes
Utilize business acumen and process improvement tools to determine flow, identify
gaps and set performance measurement standards
Conduct research and studies on focus groups to educate the community and
coordinate care
Research trends, prepare report findings, advise leadership on “best practices” and
recommend changes for growth and development
FINANCIAL MANAGEMENT
Claims Administration • Billing • Patient Registration
Exemplified knowledge of managed care guidelines, third-party payers, workers
compensation and government contracts (Medicare/Medicaid/CHAMPUS)
Demonstrated a thorough understanding of protocols, permissions, exceptions and
exclusions for insurance companies
Responsible for benefit administration of pre-certifications, authorizations, insurance
verification and appeals
Researched and resolved complex inquiries and billing discrepancies for claim
adjudication
Examined policies and informed patients of policy specifics and limitations of insurance
Served as a team lead and informed billing staff of changes in federal and state policy
Posted insurance, workers compensation and personal payments to patient accounts
Performed audits and contractual adjustments in accordance to managed care
explanation of benefits
Reviewed medical record documentation and length of stay to ensure specificity of
diagnoses and procedures for optimal reimbursement
Educated physicians on benefit information and worked with interdisciplinary
professionals to ensure that claims were processed timely and accurately
Registered patients; processed patient demographic, medical and insurance
information and initiated admitting process when applicable
Entered orders for ancillary departments and charges upon completion of services
Provided resources and county assistance for free or discounted medical care
** ACCOMPLISHMENT **
Honored Community Partnership Award for Outstanding Contributions
By National Urban League
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