S H E L B Y

B U R D E T T E

**** * ********** ****

Port Orange, FL 32128

404-***-****

adgwrf@r.postjobfree.com

SUMMARY

Skilled professional in Clinical Admin UMR CPS Claim Platform certification ICD-9 & ICD-10 Analyze claims as well as follow Up Tech with over 10 years of experience in General Clerk II, behavior Management, youth education, and project Management. Proactively develop, streamline and energize projects, programs and other disciplines to reach company financial goal. Proven record of success communicating and interacting with clients, patients, physicians, and nurses.

AREAS OF EXPERTISE

Team building & Leadership

Administrative & Caseload Management

Prevention & Management of Aggressive Behavior

Microsoft Office Proficiency

Public Relations & Community Partnerships

Resolve Customer Service Inquiries

Emergency First Aid & CPR Level B (Adult, Child & Infant)

Respond to Incoming Provider & Enrollee calls

Interview, Assessment & Negotiation

Provide Excellent Customer Service to both Providers & Enrollees

Regulatory Compliance Mentor others multitask

EMR Systems, EPIC, FIN, NextGen, & Amiysis

Organization & Time Management

Government Claims Biller/ Follow Up Tech

Payroll Specialists using Kronos system

ICD-9 / ICD-10 Coding Certificate

EDUCATION & TRAINING

DEGREE

SCHOOL

DATE

Diploma- Nursing Asst

Stratford Career Institute

March 20, 2008

Bachelor- Health care Admin

University of Phoenix

Completion December 2019/ Online

Certificate- ICD-9/ ICD-10

Baylor Scott and White Course

October 2015

PROFESSIONAL EXPERIENCE

DATES FROM: August 2014– May 2019

Senior Clinical Admin Specialist-Claims Audit Rep / Baylor Scott and White/ Temple, TX

Receives Care Coordination notification cases for non-clinical assessment/provides appropriate triage.

Set up/ documents/ triage cases for CCR Medical Claims Processing

Processes letters within DOL time frame and Assist with faxes/ emails

Process medical, commercial, and workers comp claims UB & 1500 claim forms

Provides clinical admin support the inpatient clinical team. Verifies appropriate ICD-10 and CPT coding usage

Appealed claims/ denials and forward to appropriate provider for processing

Moderate work experience within own function as well as Mentors others

Manage incoming clinical information from providers. Basic tasks are completed without review by others

Maintained a high level of data integrity and compliance. Other duties as assigned by manager and/ or director

Educated patients for home care and discharge planning.

Respond to all fax requests as well as medical terminology and medication administration skills

Cash posting payments for provider /patient as well as adjustments posted to acct

Performs Follow-ups Reviews for operational and Admin support to the department

Utilize appropriate literature to educate others on development of leadership skills

Develop strong relationships; mentor and support employees with any concerns

Contacted patients and insurance company representatives by telephone or through internet

DATES FROM: 09/2010– TO: 07/2014

Health care Admin/ Medical Claim Specialist / Hill Country Home Health care/ Harker Height, TX

Inputting patient’s insurance into the database system, and Medical Receptionist Duties

Receiving patients, insurance/ billing, EMR records, charted and documented activities

Meet weekly provider contact goals and provided excellent customer service

Schedule patient’s appointments

Performed collection activities for all/assigned accounts

DATES FROM: 06/2002 – TO: 11/2006

Medical Admin Asst / Southwest Hospital/ Atlanta, GA

Provided care to patients under the direction, and supervision of the physician

Asst the Credentialing Team by performing site visits/ surveys as needed

Collection of patient data, Medical Billing Coding, EMR records, and diagnostics

Basic tasks are completed without review by others

Some work is completed without established procedures

REFERENCES

NAME

Email

JOB TITLE

Melissa Martin

adgwrf@r.postjobfree.com

Health care Analyst

Myra Median

adgwrf@r.postjobfree.com

Regional Manager

Bryon Phillips

adgwrf@r.postjobfree.com

Master Sgt/ ARMY

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