Shelley L. Manley

**** ********* ***.

Massillon, Ohio 44646

adpmtz@r.postjobfree.com

330-***-****

SUMMARY OF QUALIFICATIONS

● Dedicated professional with over 3 years of claimsexperience in medical accident, disability, dental, vision and pharmacy claims adjudication in HMO, PPO, workers compensation, claims processing, billing, coding insurance verification, customer service and administrative duties.

● Exceptional interpersonal, organizational, multi tasking and problem solving skills.

● Ensure compliance is met by documenting, record keeping, researching accurate information and confidentiality of customer information.

● Processing of insurance claims from inception untilclosure with HIPPA compliance and CMS regulations SELECTED ACCOMPLISHMENTS

● Exceeding target expectation on claims adjudication.

● Communicate claim activity and processing to the members, insured, patients and providers, retaining a professional client relationship.

● Ensure claim files are properly documented and coding is correct for maximum profit. PROFESSIONAL EXPERIENCE

Liberty Healthshare, Canton, Ohio October 2018 - Present Medical Bill Processor

● Investigate, review, and analyze complex healthcare claims, medical records for pre existing conditions, manually calculate benefits, eligibility, and member benefits to efficiently process or adjudicate claims.

● Experience with CPT, HCPS, ICD9 and ICD 10 codes for claims

● Experienced and strong knowledge of industry standardsof CPT coding. Coordination of benefits, Medicare and Medicaid reimbursement guidelines.

● Experience with health plans benefits and financial obligations summary interpretation, EOB

● Obtain prior authorization, pre certification for participating and non participating provider services, review EOB’s for claims processed and payment posting. (copay, coinsurance, and deductible).

● Maintain all paperwork, prior Authorization, PCS forms for audit purposes

● Daily ability to handle 80-100 plus medical claims adjudication according to reasonable and customary rates, and medically necessary, benefit coverage, eligibility. LabSource LLC, Beachwood, Ohio July 2014 - August 2018 Collector

● Administered and collected drug screenings both urine and oral.

● Ensured accuracy of all patient information.

● Performed daily tasks while complying with all office guidelines.

● Conserved proper records for all insurances.

Dr. Michael Rivera-Weiss, Canton, Ohio

Front Office/ Medical Assistant October 2010 - November 2015

● Roomed patients, monitored patient’s vitals, documented patient history in EMR systems, and reviewed

● medications prescribed.

● Performed drug screens on patients to remain compliant with controlled substance laws.

● Assisted physician in pain management pre-procedures, procedures, and post-procedures.

● Cared for patients during post-operative procedures including plan of care and medications.

● Prepared and executed pre-certification of insurancefor patients.

● Organized and filed workers’ compensation forms.

● Perform all aspects of claims processing billing,coding, medical records and insurance verifications

● Experienced with primary payers EOB with ability to apply secondary payments. Spectrum Orthopedics, Canton, Ohio

Test Scheduler July 2005 - July 2010

● Managed test scheduling for outside testing for multiple physician’s orthopedic offices.

● MRI Receptionist: Assisted with checking in scheduled patients and

● Documented patient history in EMR

● Pre-certification of insurance for tests and therapyfor patients

● Used effective communication to notify patients of outside appointment times and preparations needed for specific tests.

Absolute Pharmacies, North Canton, Ohio

Billing Liaison January 2004 - July 2005

● Ensured all patient information is accurate and complete.

● Balance Absolute Nursing facilities’ medications and insurance verifications.

● Processed third party claims via electronic transmission

● Ensured all patients’ medications were ordered monthly and billed correctly to insurance.

● Effectively communicated with facilities and patients. Community Dialysis, Canton, Ohio

Dialysis Technician January 2003 - August 2004

● Responsible for communication of dialysis patients’plan of care and executed from beginning to end treatment.

● Connected hemodialysis machine to access in patients’ forearm or catheter site to start blood circulating through dialyzer and started blood flow pump at prescribed rate.

● Calculated fluid removal or replacement to be achieved during procedure.

● Ensure all machines and equipment are properly working to guarantee conformance to safety standards.

Fresenius Medical Care, Akron Ohio

Billing Liaison January 2002 - September 2003

● Reviewed and researched correspondence from insurance companies and responded to attorneys and patients.

● Researched and followed-up on denials and requested additional information utilizing the denial management reports and correspondence.

● Contacted patients as needed to collect appropriate information and/or to collect patient balances.

● Reviewed unpaid accounts and determined status with appropriate action.

● Used facility correspondence websites and phone to contacts payers regarding reimbursement of unpaid accounts.

Tomorrow’s Children of the Future,North Canton, Ohio Administrative October 2000 - December 2001

● Ordered all materials

● Corresponded with parents and staff

● Organized and recorded all tuition

● Arranged and effectively communicated staff schedules

● Assisted with all day to day operations of facility Aultman Hospital, Canton, Ohio

Central Scheduling, Radiology Assistant September 1987 - October 2000

● Organized and scheduled all radiology, outpatient surgery, heart lab testing throughout the entire hospital facility.

● Collected and registered patient information.

● Used previous X-Ray files for comparison.

● Checked-in and roomed patients prior to X-Rays being performed. EDUCATION

● Perry High School

PROFICIENCY

● Microsoft Office: Excel, Powerpoint, Word, Outlook, Access, Citrix Centricity Medisoft, EMR ATTRIBUTES

● Strong work ethics, Reliable, Ability to work independently and a a team member, Attention to detail, self-starter, organized, Multi-tasking, Problem solving, Mathematical skills, communication (verbal and written, Documentation and Customer Service Skills)

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