Medical Billing Data Entry
Resume:
Shane Schulz
Aventura, FL
advlek@r.postjobfree.com
Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
Account Specialist III
Convergent Healthcare Recoveries
March 2021 to Present
As an Accounts Specialist I would follow up on current and past current claims. I worked with the Trinity Hospital Group as a 3rd party so I worked claims from the East Coast to the West Coast and in between. Working accounts would include by not limited to usage of payer portals and or phone call to learn the current status of the claim and if full reimbursement was achieved. I would work these similar to an auditor going from the very beginning because in my experience the issue a claim may be having generally would start in the beginning whether it be coding related, prior authorization etc. I would work with my team if a utilization management review was needed to give more support to medical necessity for an appeal or peer review.
Another aspect of my position was also to assist in reporting. I have a vast amount of experience with databases and excel to where I would be able to find glaring issues and or trends that could have a bulk adjust ment or project to be able to stay within timely filing perimeters for initial and or appealed claims. Accounts Receivable Consultant
Robert Half Account Temps - Albany, NY
April 2015 to Present
• Filled in as the Accounts Receivable Coordinator for residential recovery program
• Maintained patient A/R records from admission through discharge
• Payment posting for all insurance carriers
• Billing for services provided to all carriers specializing with Medicaid from multiple states.
• Denial management
• Reconciled A/R accounts including over payments and earlier posting errors. Filled in as the Accounts Receivable Coordinator for residential recovery program
Robert Half Account Temps
September 2015 to October 2015
Temporary Assignment)
● Filled in as the Accounts Receivable Coordinator for residential recovery program
● Maintained patient A/R records from admission through discharge
● Payment posting for all insurance carriers
● Billing for services provided to all carriers specializing with Medicaid from multiple states.
● Denial management
● Reconciled A/R accounts including over payments and earlier posting errors. Temporary assignment mainly to perform cash recovery for claims as late Robert Half Account Temps
April 2015 to July 2015
as 4 years old.
● Manipulated raw data for accounts receivable by using expertise of excel to see different patterns of process and issues so to reconcile payments for these significantly older dates of service
● Contacted all insurance carriers to learn of issues and to initiate actions needed for payment to be made possible ie. Corrected billing, provide explanation of benefits from the primary carrier and the appeals process.
● Reported pattern issues that were the cause for claims not to be paid on by the carrier.
● Reported and researched missing payments from the carrier to the provider ie. Old addresses, wrong provider profile, W9 information updates.
On site Manager of a Cash Recovery Project
Med Scribe Inc
March 2011 to December 2011
Represented both Med Scribe and their client as an On Site Manager to assist a regional hospital and its associated physicians group during a contracted cash recovery project.
• Provided leadership and training for a team of 8 to pursue receivables concerning in- patient, out-patient hospital and their associated physicians claims for services rendered.
• Acted as a liaison between the client and the project in numerous ways. Included but not limited to work flow, problem solving, process enhancing, personnel issues, etc.
• Represented the client and the provider while having numerous communications with random insurance carriers largely regarding claims resolution issues. As the On Site Manager I would often 2
have meetings with Provider Representatives of these carriers whether in person or by phone to discuss claim and process management.
• Worked with all departments and management of the mentioned provider including but not limited to the Information Systems, Front End, Central Business Office, Accounting and Upper Management to improve broken or outdated processes along with providing expertise in the medical billing / revenue cycle process.
• Devised numerous reports and workbooks to follow the progress of the project detailing glaring issues and trends. As the Project Manager I would provide a monthly summary report for the provider to be presented during financial committee and committee of upper management to include both a brief and detailed summary of activity and progress of the project to date. Medical Billing Specialist
Prime Care Physicians - Albany, NY
June 2007 to November 2010
Managed all patient accounts related to random insurance carriers specializing with a specific payer of benefits (CDPHP) for a large medical group. Claim issues would concern primary care, urgent care, radiology, cardiology and electrophysiology related charges.
• Accounts Receivable Management- Utilized the fundamentals with a maximum effort to achieve the current goal. Focused on high dollar to low dollar concept to have the most effect in a timely manner.
• Denial Management- Devised and utilized reports and spreadsheets to sort the same information in numerous different ways to be able to find glaring issues as well as be able to ensure claims are corrected and resubmitted in a timely manner for payment.
• Relationships - With my employer being a significantly large medical group it is imperative to develop good working relationships both of the employer and of the employees of the insurance payer that I work with. This creates a cohesive process to ensure the cooperation that is needed to correct or appeal claims, obtain medical records that are critical to denial issues etc. etc. Account Manager
Etransmedia - Troy, NY
October 2006 to March 2007
for providers concerning primary care, gastroenterology & pediatrics.
• Oversaw all patient accounts for contracted doctors. Volume of patients would range between 1000, to 3500 patients depending on the provider.
• Q&A of all charges submitted as well as all payments received ranging from patient payments to all related insurance payments
• Corrected and submitted all claims required for the appeal process. 3
• Posted charges and payments that required special attention ie. Place of service reductions or multi surgery reduction payments etc.
• Managed all accounts receivable including collection from the patient's insurance coverage.
• Devised daily, weekly, and monthly reports utilizing excel spreadsheets to show progress and glaring issues that would require attention to be corrected so to satisfy the claims effectively and in a timely manner.
• Communicated daily with the respected providers so to manage their accounts effectively such as updated charges to be billed, CPT, and ICD9 codes to be both AMA and Medicare compliant.
• Corrected numerous issues that would keep a claim from being billed out electronically including AR
& Insurance coding, required authorizations from referring providers, admission dates etc. for whatever medical management software that would pertain.
• Considered a point person for special projects and continual training for current team mates concerning software, billing and account management issues.
Medical Billing Specialist
Snelling Associates - Albany, NY
April 2006 to August 2006
Claims Follow up Specialist
Snelling Associates
April 2006 to August 2006
• Satisfied over 80 outstanding claims daily utilizing phone, internet and email applications.
• Prepared and submitted bad debt forms for outstanding claims that are either passed timely guidelines and or not able to be validated with sufficient documentation.
• Utilized excel to show progress as well as to detect patterns of issues that may need to be addressed.
• Managed over appeals to various insurance carriers that help validate the submitted charges. Senior Customer/Provider Representative
Value Options - Troy, NY
February 2000 to March 2001
Provided assistance with claim and or benefit issues for the state contract of New York. The Empire contract consisted of over 200 thousand members.
• Trained new and existing representatives' customer service and claim related skills to provide timely and efficient service.
• Accepted the role as "point person" for claim/provider related issues that were categorized as "priority status".
• Satisfied between 75 - 100 benefit/claims/provider related issues daily. Member Services Representative
Kaiser Permanente - Latham, NY
October 1998 to February 2000
*NOTE* Kaiser Permanente Closed all offices within the North East Region. The Empire Plan was assumed by Value Options for Behavior Health related issues.
• Provided Benefit information and claims assistance for the State of New York contract. Calls regarded routine and major medical issues.
• Worked with over 70-100 claims/benefit issues daily
• Worked as a liaison between members and their local providers. This helped ensure member claims/benefit related issues are satisfied in a timely and accurate manor Education
certification in Certified Professional Medical Auditor La Salle Institute of Troy N.Y. - Troy, NY
September 1985
Skills
• ICD-9
• Process Management
• Medical Billing
• Medical Management
• CPT Coding
• Medical Management
• ICD-10
• EMR Systems
• Insurance Verification
• Medical Management
• Accounts Receivable
• Medical Coding
• Medical Records
• Medical Management
• Medical Office Experience
• Accounting
• Microsoft Outlook
• Communication skills
• Data entry
Certifications and Licenses
Medical Coding Certification
Assessments
Electronic health records: Best practices — Familiar March 2021
Knowledge of EHR data, associated privacy regulations, and best practices for EHR use Full results: Familiar
Analyzing data — Proficient
March 2021
Interpreting and producing graphs, identifying trends, and drawing justifiable conclusions from data Full results: Proficient
Supervisory skills: Motivating & assessing employees — Highly Proficient June 2022
Motivating others to achieve objectives and identifying improvements or corrective actions Full results: Highly Proficient
Attention to detail — Highly Proficient
June 2022
Identifying differences in materials, following instructions, and detecting details among distracting information
Full results: Highly Proficient
Medical billing — Highly Proficient
June 2022
Understanding the procedures and forms used for medical billing Full results: Highly Proficient
Medical terminology — Familiar
June 2022
Understanding and using medical terminology
Full results: Familiar
Business math — Highly Proficient
March 2021
Using basic math to solve problems in a business context Full results: Highly Proficient
Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
Contact this candidate