Communication Skills Special Projects
Resume:
Paulette Shreve-Burrell
Objective:
To secure challenging position, as a Claim Analyst or Biller, that will bring into service my inexhaustible experience while affording me the opportunity to remain steadfast in my commitment to proficiently evaluate submitted claims and utilize my analytical skills to seek agreeable resolution to claims issues while maintaining a positive and productive rapport between client and company. Seeking a claim Analyst position or Biller position where my skills in evaluating claims submitted would help resolving disputes and maintaining relationship between client and company.
Professional Highlights:
●Demonstrated negotiation and mediation skills
●Excellent analytical, interpersonal, written and oral communication skills
●Highly efficient and well-organized
●MS Word, Excel and PowerPoint, EPIC, THOMAS, AVAILITY, PREMIS
CTProbill Billing -IPS SOLUTIONS 8/23-12/23
Work all clients according to the date they are billed per the clinic’s Office List.
Prior to working with each client, check the office list for any billing updates daily.
Review all claims ready for submission. Scrub them for appropriate modifiers and/or
anything that may need to be corrected. Correct everything before submission. All
charges should be within established guidelines based on insurance carrier of
appropriate modifiers and/or referrals and/or authorizations.
Process the clients claims (EDI/Paper).
Fix any incorrect paper charges waiting to be billed with wrong paper claim
selection for all clinics. Work / resolve all scrubbing errors daily. Check the clearinghouse within 24 hours to confirm that claim files were received. Review and work your rejections for each client you manage within 7 business days of the
rejection.
Emory Healthcare 11/21–5/23
●Billing Commercial and Medicaid claims for all Emory hospitals for Inpatient and Outpatient claims.
●Billing for medium and low dollar claims, daily reconciliation, registration, auditing, and collection of information.
●Collaborate with other team members on special projects and events.
●Evaluate patient records for suitability, completeness, and correctness of health data.
●Record data electronically for collection, storage, analysis, recovery, and reporting.
●Arrange and maintain data for medical databases and registries.
●Utilize classification software to assign clinical codes for reimbursement and data analysis.
●Protect patients’ healthiness information for privacy.
●Prepare, key in, edit, and proofread health check records also a Preceptor.
●Work excel reports, MM, BR, 881, EPIC
Employment History:
Biller/Collector (Contract) 11/2020 - 11/21
Shepherd Center – Atlanta, GA
●Follow-up on all commercial insurances.
●Work with very high dollar claims.
●Monitors unbilled accounts and prepares status reports weekly for the supervisor.
●Responsible for ensuring monthly cash goals are met.
●Ensures that accounts are appropriately coded to system requirements for management of open accounts.
●Ensures all billing activity is posted to A/R system.
●Obtains medical records from HIM in a timely manner and ensures all that is needed for payment is attached at the time of billing.
●Works with outpatient access and inpatient financial counselors to ensure all referrals and prior authorizations are completed and loaded in the system accurately prior to submission of bill.
●Obtains payer requested documents to ensure timely payment.
●Work on Epic system.
Medical Biller (Contract) 03/2020 – 06/2020
Pruitt Healthcare – Norcross, GA
●Supports the delivery of all insurance billing services by final/higher level auditing, correcting and submitting claims.
●Ensures that billing services are timely, accurate and allow for appropriate reimbursement.
●Conducts all claims-related follow up on payment delays, taking corrective action(s) to finalize account disposition and/or referring claims to the appropriate staff to ensure appropriate reimbursement in the timeliest manner possible.
●Conducts month-end close and cash posting responsibilities for all assigned locations.
Patient Accounting Representative 11/2014 – 3/2020
Sentara - Chesapeake, VA
●Billing Commercial and Medicaid claims for 12 hospitals for Inpatient and Outpatient claims.
●Billing for medium and low dollar claims, daily reconciliation, registration, auditing, and collection of information.
●Collaborate with other team members on special projects and events.
●Evaluate patient records for suitability, completeness, and correctness of health data.
●Record data electronically for collection, storage, analysis, recovery, and reporting.
●Arrange and maintain data for medical databases and registries.
●Utilize classification software to assign clinical codes for reimbursement and data analysis.
●Protect patients’ healthiness information for privacy.
●Prepare, key in, edit, and proofread health check records also a Preceptor.
●Work excel reports, MM, BR, 881, EPIC
Account Services (Contract) 08/2014 - 11/2014
Optima Health - Virginia Beach, VA
●Provided guidelines for the workflow of the Individual Product for the finance department.
●Individual Product is an insurance plan offered to individuals who do not have health coverage through an employer group.
●Answered calls from the members and processed premium payments.
●Mailed out EOB for members as well as batched up payments for scanning.
Claim Analyst 02/2010 - 08/2014
Midwest Health Plan – Dearborn, MI
●Analyzed claim issues from identification to resolution.
●Identifying claims, processing anomalies and offer solutions to address.
●Completing root cause analysis for claims that are not processed accurately.
●Identifying system or process deficiencies and offer suggestions for corrective actions.
●Through analysis and process improvement, assist with accuracy, timely research and adjudication of claim recoveries and over payments including.
●Coordination of benefits/other health coverage, Medicaid plans, adult benefit Waiver plan, Health Choice plan, My child plan.
● Collaborated with other team members on special projects and events.
●Delivered exceptional service by greeting and serving providers in a timely, friendly manner.
Insurance Verification 11/2009 - 01/2010
New Center Mental Health Center - Detroit, MI
●Reviewed Csnap for Medicare benefits and Medifax for Medicaid benefits as well as checked Web Denis for Blue Cross benefits.
●Updated client patient’s record.
●Delivered exceptional service by greeting and serving customers in a timely, friendly manner.
●Handled and distributed all incoming and outgoing mail.
Patient Accounting Representative 05/2007 – 06/2008
Detroit Medical Center - Detroit, MI
●Executed followed up Medicare, BCBSM and Bcn, and Commercial and Medicaid claims for physicians billing for payment.
●Worked individual portfolio accounts from a prioritize work list.
●Confirmed current outstanding balances and performed appropriate account follow up, as well as analyzed and responded to claim denial.
●Collaborated with other team members on special projects and events.
●Handled and distributed all incoming and outgoing mail.
Biller & follow up 08/2002 – 03/2007
St Mary Hospital - Livonia, MI
●Executed followed up and direct billing for Medicare, BCBSM and Bcn, and Commercial and Medicaid claims for physicians billing for payment.
●Worked individual portfolio accounts from a prioritize work list.
●Confirmed current outstanding balances and performed appropriate account follow up, as well as analyzed and responded to claim denial.
●Collaborated with other team members on special projects and events.
●Handled and distributed all incoming and outgoing mail.
Education:
Health Care Management: Madonna University - Livonia, MI Pending
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