Shonda Anderson

940-***-**** ô acxtr2@r.postjobfree.com

Prior Experience

June 2010-Jan 2011 Sagebrush Solutions Addison, TX

Senior HIM (Healthcare Information Management) specialist

Recurring, repetitive collective activities, claim interpretation, secondary processing, critical thinking,

April 2008-May 2010 Dell Perot Systems Corp. Dallas, TX

Senior Auditor - Quality Compliance Support

Researching & identifying erroneous claim payments, time management, documenting root cause analysis, determining necessary course of corrective action & prevention analysis. Client liaison, SME & stop loss, team lead advisory capacity, active listening, training & retraining, focused audits, same day feedback, weekly status meetings, prevention analysis, coordinating tasks, managing conflict, documenting necessary course of corrective action, coaching, motivating, meeting production goals & broader objectives, enforcing policies, punctuality, accountability, active learning,

Nov 2006-April 2008

Senior Level Claims Examiner - Mgmt Training

Subject Matter Expert (SME); trainer to claims team; auditor, point of client contact, adjusting processed errors, determining benefits, processes & procedures, operational assistance, medical billing guidelines, state mandates, Reporting information, Editing, setting, gauging & meeting deadlines, organizing, accepting responsibilities, delegating, attending detail, information gathering, problem solving, extracting important information, prioritizing, critical thinking, public speaking,

July 2006 - Nov 2006 Saint Francis Hospital Tulsa, OK

Expired Account Reconciliation Specialist - Contracted

Collected over 2M in internally amortized (written off) funds; reconciling expired insurance claims, high dollar claims over 365 days expired; defaulted on by insurance companies for various reasons; expanded to 180 day arrears.

Oct 2005 - May 2006 Keller Williams Realty Denton, TX

Office Manager

Marketing budget, expense accounts, accounts receivable & payable, event planning & coordination. Contract negotiation, Offer negotiations, design & maintain website, contract - filing legal documents, customer database maintenance - lead generation, maintenance; contract to close, writing,

Sept 1999 - Jan 2005 Great West Healthcare/One Health Dallas, TX

Claims Examiner

Interpret client benefits, anticipate/calculate claims, fund medical payments, identify & adjust errors, weekly/monthly reports, interdepartmental meetings (non-group & client based), exemplary computer skills, minimal accounting required, minimal supervision, precision, attention to detail, accuracy, medical coding interpretation, medical billing guidelines, state mandates, ERISA, HIPPA, CPT4 processing, Medicare/Medicaid knowledge

Customer Service Rep

Fanatical customer service, problem identification & resolution, scripting solutions/creation/determination. Adhere to workflow & corp. determined guidelines, access rep. compliance w/ established guidelines, processes, scripts & workflows. Process improvement, continuous training & system improvement, individual problem area resolution, role playing scenarios (training/preparedness). Situational judgments - SME (Subject Matter Expert) w/ Supervisory Override

Provider Relations

Maintaining accurate provider records, updating & negotiating provider contracts, database maintenance, point of service marketing

Utilization Review Support

Reviewing claim information & records to determine medical necessity of procedures submitted for prior authorization; working directly with Medical Director, approval of simple/routine procedures based upon submitted diagnosis codes; denial of cosmetic procedures

Precertification

Data entry & approval of submitted procedures

Receptionist

Phone system maintenance, filing, administrative duties

Education

March 2010 University of Phoenix Irving Campus, TX

MBA

2002-2004 Northwood University Cedar Hill, TX

BBA

1993-1996 Northeastern State Univ. Tahlequah, OK

1996-1997 Tulsa Community College Tulsa, OK

1991-1993 Sapulpa High School Sapulpa, OK

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