Antonia Vernell Rich-Shuron

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

Baltimore, MD 21215

aduqfh@r.postjobfree.com

717-***-****

PROFESSIONAL SUMMARY

Highly skilled Billing & Customer Service Administrative with over 20 years of exemplary experience working in a medical office and hospital environment (Specialties include but not limited to DME, Anesthesia, Mental Health, Pain Management, Ambulance, Oncology, Gastroenterology and Internal Medicine Billing); Billing and Credentialing Consultant with over 5 years of annotated service to providers of healthcare; Also attained 5 years of experience in Management-Human Resources-Payroll-Accounting at a Tag and Title Service.

AREAS OF EXPERTISE

Extensive knowledge of ICD9, ICD10, CPT4, HCPCS and DRG Billing and Coding and Charge Review

Excellent knowledge and understanding of the provider and facility/group credentialing process for in network access to multiple insurances such as Medicaid, Medicare, Carefirst/Blue Cross Blue Shield, Aetna, Humana/Tricare, United Health Care/Optum and all of the MCO’s.

Extensive Knowledge of Medical and Surgical Terminology and disease process as related to coding

Thorough understanding of reimbursement terminology for private insurance, Medicare, Medicaid, Self-Pay and Workers Compensation

Working knowledge and understanding of Human Resources as it relates to operations (from hiring, training, testing, payroll, auditing, state compliances to termination)

Extensive years of experience in Billing submitting paper and electronic claims, coding/reviewing charges, posting payments and denials, filing appeals, claims review and AR follow up

CORE QUALIFICATIONS

Excellent oral and written communication (including typing letters, memos, sending/receiving emails and creating spreadsheets using Microsoft Office and Excel).

Experience monitoring timekeeping/timesheets with Intuit QuickBooks, Kronos Workforce Timekeeper and Payroll Management

Able to work independently with minimal or no supervision (HIPAA Compliant; Maintain strict confidentiality)

Able to be a team player and establish and maintain effective working relationships with providers, management, staff and contacts outside of the organization

Able to proficiently use several varieties of old and new Medical HER Billing Software such as EClinical Works, Simple Practice, Theranest, Kareo, Incedo, Epic, IDX, Medisoft, Care Metrix, Greenway Intergy, Icanotes and Advanced MD.

Able to plan, organize, prioritize multiple projects/Deadline Driven

Able to research and analyze medical claims, claim reports and documentation according to policy; Excellent Attention to Detail; Exercise good judgment

Experience with onboarding, training and out processing

Experience monitoring, adjusting and updating schedules

Strong Work Ethic, positive leadership attitude and open to learning new things (Unafraid to ask questions)

Handled all Employee Relations and appeared in court as representative for Worker’s Compensation and Unemployment hearings.

Implemented health benefits and retirement options for employees: Also handled open enrollment

Technological Aptitude to handle IT related issues on a help desk level

Handled work related injuries and illnesses; Handled incident reports and investigations

SPECIAL SKILLS

Communication, Interviewing and Orientation Skills

Handling New Hire Onboarding Process and Paperwork

Developmental and Decision Making Skills

Entering, Submitting and Processing Payroll for 30+employees

Audit Paperwork to Ensure Compliance (Meet Deadlines)

Peoplesoft Software

Great listening and empathetic skills

Document Scanning-Filing

Handle Reimbursements and Appeals

Performance Management according to OPM

Teamwork and Collaboration

Filing/Pulling Medical Records/Remittances/EOB’s

Claim Filing (Paper & Electronic/EDI)

Data-Charge Entry-Facsimile

Verifying Insurance/Co-Pays

Posting Payments/Denials-A/R Follow Up

Call Center/Customer Service Skills

Handling Front End Rejections

Budgeting Skills/Running Reports

Scheduling Skills

Human Resources Information Software (HRIS)

Project Management

PROFESSIONAL EXPERIENCE

Consultant/Contractor

Enrollment Specialist/EDI/Implementation Specialist-Medical Biller/Provider Credentialing-Admin/Customer Service/Intake/Scheduler

2017-Present

Private Contracts-References Available

CONTRACT 6/2022-1/2023

Technology Navigators

Enrollment Specialist for an EDI/Implementation Project

Duties involved updating spreadsheets, creating and closing cases in Salesforce, looking up data in Practice Insight and correcting conversion errors in a system called Aprima

(Contract ended 12/30/2022)

CONTRACT 1/2021-1/2022

Ageatia Technologies

Customer Service Representative

Duties included answering 30-50 calls daily in a call center environment. Also was responsible for. assisting Carefirst enrollees with member services and providers with claims information and assistance.

CONTRACT 1/2020-1/2021

Transformation Health

Intake/Scheduling Coordinator

Was responsible for making calls to referrals and completing their Intakes for Mental Health which entailed registering and scheduling patients in Icanotes and answering the phone for a Mental Health Clinic. Also answered calls and logged calls in Sharepoint and created, updated and maintained several other spreadsheets in Excel, ran daily No Show reports and contacting those clients to re-schedule missed appointments, Entered Authorizations into Incedo, verified insurance for new and existing clients and scheduled and rescheduled clients

OTHER CONTRACTS………

Submitted claims through Simple Practice EHR for Mental Health, posted payments and provided AR follow up on unpaid claims (including appeals and resubmitting claims)

Submitted Mental Health claims in Incedo, EClinical Works, Simple Practice

Reviewed charges in Epic

Provided Billing and AR Follow up for Gastroenterology using EClinical Works and Epic. Also used several provider portals such as Navinet, Carefirst Direct, Cigna, UHC, Provider Express Pear Portal and Availity

Provided Billing and AR Follow up for Mental Health through Kareo, Theranest and Simple Practice for several clients

Handled all incoming faxes and fulfilled all Medical Records requests for a pain management office

Provided provider credentialing for various providers and groups to become a participating provider with Medicare, Medicaid, Carefirst, Aetna, United Healthcare, Cigna etc

Residential Assistant II

2011-2021

State of Maryland-DHMH-SETT Unit at Potomac Center

Hagerstown, MD

Provided care, custody and guidance for court ordered individuals with intellectual disabilities

Promoted personal growth and productivity by enhancing each individuals skills and decreasing or eliminating maladaptive or socially unacceptable behaviors

Managed aggressive behaviors and assist individuals to court, medical appointments, hospital emergencies, clinical services, etc.

Ensured security of the unit by maintaining counts, making rounds periodically and standing guard at fixed posts

Conducted random searches of individuals rooms and grounds for weapons and other contraband

Used computer, telephone, copier, facsimile, calculator, scanner, fire extinguisher and

First aid equipment/PPE if needed

Assisted individuals with academics, physical activities and personal hygiene etc.

Office Manager

2004-2011

Perfection Title & Tag Service

Pikesville, MD

Provided excellent customer service to customers who required DMV services through the State of Maryland

Developed and implemented HR strategies and initiatives aligned with the overall business strategy

Bridged management and employee relations by addressing demands, grievances or other issues

Managed the recruitment and selection process

Supported current and future business needs through the development, engagement, motivation and preservation of human capital

Developed and monitored overall HR strategies, systems, tactics and procedures across the organization

Nurtured a positive working environment

Overseen and managed performance appraisal system that drives high performance

Assessed training needs to apply and monitor training programs

Reported to owner and provided decision support through HR metrics

Ensured legal compliances throughout human resource management

Handled daily payment transactions and ran daily A/R reports

Handled complex/serious DMV issues by visiting the main DMV branch

Delivered tags, titles and important documents to our elite clients/car dealerships

Handled payroll and employee timesheets

Handled hiring/disciplinary action of clerical staff

Handled all work related injuries and Workers Compensation hearings (working knowledge of Workers Compensation laws and regulations

Handled all Unemployment situations as well as attended hearings (working knowledge of Unemployment laws and regulations

Claims Resolution Specialist

2000-2004

Magellan Health Services

Columbia, MD

Submitted claims for reimbursement to private insurers, Medicaid and Medicare for mental health services

Stayed abreast of federal coding requirements, guidelines and updates

Randomly audited claim submissions for accuracy; corrected errors/omissions

Performed insurance and referral verifications

Tracked and resolved underpayments

Posted payments and adjustments

Completed appeals from beginning to end

Reviewed medical records for accuracy

Entered charges/procedure codes

Identified errors and refilled denied/rejected claims

Obtained, prepared and attached all required documentation such as referrals and treatment plans to reduce incidence of denials

Education/Certifications

Ashworth College-Online Attending

Medical Billing and Coding Certificate Program

American Red Cross- Baltimore, MD 2010

CNA/GNA Certificate Program

Health Focus of Maryland – Baltimore, MD 2014

CMT Certificate

Walbrook High School – Baltimore, MD 1989-1993

DIPLOMA Received

REFERENCES AVAILABLE UPON REQUEST

Contact this candidate