**/**** ** *******

United States

**/**** ** *******

United States

**/**** ** *******

Remote, United States

SHYLA ROBINSON

SUMMARY

Results-driven Claim Processor with 13 years of experience. Expert in thorough policy and contract analysis, meticulous review of medical bills/records for precise payments, and delivering outstanding customer service. Proven track record of effective communication with policyholders, claimants, and healthcare providers while ensuring compliance with best claim practices and state laws. Proficient in CPT®, ICD-10-CM, and HCPCS Level II Coding, as well as maintaining HIPAA compliance and optimizing claims management. Eager to apply extensive skills and achievements in a new Claim Processor role. SKILLS

Claims Adjudication

Customer Service

Time Management

Computer Proficiency

Ethical Judgment

Negotiation Skills

Knowledge of Insurance Policies

Conflict Resolution

Team Collaboration

HIPAA Compliance

Customer Relationship Management

Knowledge of ICD-10-CM, CPT codes

Medical Claims Processing

Accuracy in claims management

WORK EXPERIENCE

Crisis Counselor Volunteer

The Crisis Center

Demonstrate effectiveness in providing timely and empathetic support, resulting in a measurable reduction in individuals' immediate distress during crisis situations.

Apply active listening techniques to assess and understand individuals' concerns, leading to more accurate and personalized crisis interventions.

Enact crisis intervention strategies, resulting in a significant percentage of individuals reporting reduced emotional intensity and stabilized mental well-being.

Improve individuals' access to appropriate resources by providing accurate information and referrals, contributing to a higher rate of individuals seeking ongoing support.

Implement a streamlined documentation process, resulting in accurate and comprehensive records. This contributes to improved organizational reporting and enhances understanding of crisis patterns for future interventions. Founder/Volunteer (Board)

RWCO Non-profit Organization

Designs a comprehensive fundraising plan resulting in a 30% increase in funds raised compared to the previous year, achieving a total of $100,000 in donations.

Spearheads strategic planning initiatives, guiding the organization's mission, vision, and objectives to ensure alignment with its overarching goals and community impact.

Cultivates and maintains key partnerships and relationships with stakeholders, donors, and community leaders to enhance the organization's visibility, credibility, and overall effectiveness in achieving its philanthropic mission. Organizes and executes a large-scale community event, providing food and clothing to over 500 individuals and delivering job readiness training to 50 participants, profoundly impacting the local community. Developed compensation, succession and benefits programs supporting organization's objectives. Benefits Adjuster III

American Public Life Insurance (APL)

Achieves significant improvements in overall processing accuracy by precisely evaluating policy coverage and eligibility across more than 100 policy contracts.

Implements strategies that lead to an 80% reduction in costs and improve billing accuracy by identifying and rectifying discrepancies, resulting in a substantial enhancement in overall financial efficiency. Linkedin.com/in/shyla-r-13095b135 Jackson Mississippi, United States 601-***-**** ad3p95@r.postjobfree.com 05/2010 to 10/2016

Jackson, Mississippi Area

02/2011 to 10/2016

Jackson, MS

05/2018

Consistently delivers exceptional customer service, resulting in a noteworthy increase in customer satisfaction ratings and substantial growth in overall customer contentment.

Guides the implementation of optimal claims practices, resulting in a doubling of processing efficiency and a 75% reduction in processing time.

Collaborates seamlessly with liability, underwriting, and special investigations teams to mitigate undesirable risks, resulting in a substantial reduction in potential financial losses and the prevention of high-risk incidents. Benefits Coordinator

Baptist Hospital

Effectively processed and validated 100 claim submissions daily, ensuring 100% documentation completeness. Conducted meticulous verification of medical codes, eligibility, authorizations, and benefits, resulting in an impressive 98% accuracy rate.

Instrumental in achieving a remarkable 90% reduction in claim adjudication errors by strictly adhering to policies and enhancing operational compliance.

Demonstrated proficiency in electronic health record system usage, achieving a notable 98% accuracy rate in data entry and record audits.

Consistently met or exceeded Key Performance Indicators (KPIs), underscoring dedication to operational excellence, which significantly contributed to departmental goals and highlighted a commitment to delivering high-quality outcomes in the field of claims processing and validation.

Patient Access Specialist

St. Dominic Hospital

Successfully verified insurance coverage for more than 200 medical charges within specified timeframes, resulting in an enhanced billing process and reduced payment delays.

Skillfully managed the resolution of payment discrepancies, ensuring accuracy and smooth financial transactions for both patients and providers.

Maintained a 97% accuracy rate in processing claims, utilizing proficiency in medical terminology, CPT codes, and ICD-9 codes. This commitment to precision guaranteed the efficiency of billing procedures. Achieved a consistent 95% positive satisfaction rating from patients, family members, and medical staff through proactive communication and effective resolution of concerns. Contributed to fostering a positive and collaborative healthcare environment. EDUCATION

Bachelor's Degree: Healthcare Administrator/ Public Health Jackson State University

Crisis Counseling Certification: Counseling Psychology Crisis Counseling Program

CERTIFICATION

Certification in Mississippi Prelicensing Education - Life and Health Insurance ACTIVITIES

Mentor Running With Christ Outreach

REFERENCES

References available upon request.

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