SHARON M. CHANDLER

**** * ******* ****** *****, FL 33603

adw56g@r.postjobfree.com

813-***-****

PROFESSIONAL SUMMARY

A dedicated and knowledgeable insurance professional, with a passion for serving others. I am self motivated, results driven yet personable and a pleasure to work with. I have extensive experience of 20 years in Medicaid and Medicare.

EDUCATION-2007-2012 University of Tampa

EMPLOYMENT

CENTENE HEALTH PLANS June, 2018-October, 2022

Appeal Intake Specialist

Load provider or members appeals into iCP

Contact providers regarding their appeals

Maintain daily production goals

Keep daily production logs by creating excel spreadsheet

Attend weekly meetings via zoom

Work with internal departments to coordinate completion of work queues

WELLCARE HEALTH PLANS. October, 2017-June, 2018

Provider Operations Coordinator

Review expansion contract documents to ensure they are in good order

and configurable

Clear all exceptions and process all PRR Reviews within twenty-four hours

Pull credentialing applications from CAQH by CAQH number, name, or NPI

Evaluate all credentialing documents such as COI, Collabs, CLIA, DEA licenses, etc. to ensure that they are in good order for processing

Create PLF’s for physicians, ancillary providers, and facilities for multiple states and lines of business

Exceed productivity standards for creating PLF’s and scrubbing credentialing documents

Make outbound provider calls for missing items in order to complete a PLF or credentialing packet

July 19, 2016-June, 2017 MOFFITT CANCER CENTER

FINANCIAL SPECIALIST III

Reviewing scheduled appointments, planned surgeries and planned admissions to ensure all aspects of insurance approval have been met for each encounter.

Pay attention to detail as review each patient's treatment plan and insurance benefits to ensure that all information is accurate and that pre-certification or authorization is obtained from the payor and/or primary care physician.

Follows up on errors and offers contributions and suggestions to improve current methods. Contributes innovative ideas to improve work practices and flow.

October, 2016 – June, 2017 ADVENT HEALTH

FINANCIAL SPECIALIST II

Answer inbound calls to the department from patients, attorneys, and insurance companies.

Make payment plans and offer pay in full discounts to patients.

Review account charges and balances with Payers

Mail statements to patients

Properly document each account accessed.

Collect as much possible from payers and patients to reduce outstanding balances.

September, 2015- July, 2016 LAKELAND REGIONAL HOSPITAL

FINANCIAL SPECIALISTS

Verify insurance and process ambulatory surgeries and office specialist appointments for the Cancer Center.

Work from a work-list for my assigned Doctors to clear lists in a timely manner.

Assist Radiology with their work-list when I have completed my list.

Contact patients to verify new insurance information.

Maintain weekly production percentage and logs.

November, 2013 – November, 2014 ELECTRO MEDICAL INC.

MEDICARE/MEDICAID COORDINATOR

Process Intake applications for Medicare patients to receive Durable Medical Equipment

Enter all of the patients Demographics into a data base

Verify patients Medicare status by using CMS website and NEBO

Ensure that the Prescriptions are completed correctly according to Medicare’s guidelines.

Contact providers if corrections are required for the prescriptions

Contact patients outbound via phone or email or mail

Answer inbound calls from providers or patients to answer their inquiries regarding their equipment

June 2012- Sept 2013 TRAVELERS INSURANCE APPEALS SPECIALIST

Review and process workers compensation claims according to work flow

Consistently provide high-level customer service internally.

Review Workers Compensation appeals and process according to denial reasons.

Queue Workers Compensation appeals to be reviewed by Coders

Maintain a production log daily.

Complete assigned task assigned by temp supervisor in a timely manner.

Perform various tasks as needed or requested by management.

Continually acquire, develop and refine skills as a claim professional

REFERENCES - AVAILABLE UPON REQUEST

STRONG ATTRIBUTES

Extensive knowledge of CPT& HCPCS codes, Medicaid Fee Schedule, Medical Terminology

Strong Knowledge base on Stop Loss, DRG’s, IPPS, Contract language, Uniform billing CMS 1500 and UB04’s.

Familiar with billing and payment guidelines Medicare & Medicaid reimbursement

Quality focused

Strong customer services orientation

Articulate and clear speaking tone

Able to work independently and under pressure with great

Organization skills

Proficient in MS Office, Microsoft Excel, PowerPoint, Internet

Software knowledge: Facets, EMR, iCP, Toolbox, PEGA, XCELYS, CAPSTONE, AVAILITY, LAWSON, Prism, IDX, CARS, Microsoft Excel, MS Word, PowerPoint, Outlook, Webstrat, IDT, Cosmos. And GPS Resolution, E-fax, Printer copier, scanner.

Always wearing a smile and positive attitude.

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