TIFFANY SHEWMAKER

*** ******* #* ~ San Antonio, Texas 78226

210-***-**** ~ adyj89@r.postjobfree.com

OBJECTIVE

Medical enthusiast seeking opportunity to work in an environment as a team member where my coding/billing, prior authorization, claims processing and/or medical training can be utilized.

SKILLS

Medical Terminology

Familiar with various types of claims

IKA and DOCDNA

Microsoft Office Suite (Excel, Outlook, etc)

10 Key by touch

Type 50+ wpm

Medical law/Ethics

Various Windows applications

Familiar with Internet/Intranet sites

Office procedures/Business Communications

EDUCATION

Southern Careers Institute – San Antonio, Texas (05/2013 to 02/2014) Pharmacy Technician Program

Career Quest – San Antonio, Texas (03/2003 to 10/2003) Medical Information Management

WORK EXPERIENCE

QTC Medical Services San Antonio, Texas (3/2022-Present)

Medical Claims Specialist (CS)

Third party scheduling for VA. Scheduled evaluations for Veterans for their compensation and pension disability benefits. Worked with claims from the PACT ACT, Gulf War and TERA (Toxic Environmental Risk Assessment) divisions of the military experiences. Worked with claims that have been through the court system to determine if more indepth attention needs to be made in the evaluation. Spoke with the Veterans on a daily basis scheduling evaluations, answering questions, clarifying information with the VA regarding various situations.

United Health Group-WellMed San Antonio, Texas (04/2017-03/2022)

Sr. Data Entry Specialist/Claims Examiner

Data entry of claims into IKA from email or DOCDNA. Send Return to Provider letters for reasons such as member not found or in need of additional information in order for the claim to be processed. Sort mail and distribute as required. Log status of Humana claims (entered or sent back for more information). Verify status of cost share on claims and making adjustments as needed per plan. Process both HCFA and UB claims to include cost share, interest, etc.

CVS Caremark San Antonio, Texas (03/2014 to 02/2016)

Pharmacy Tech/Pre Authorization Tech

Answered calls from doctor’s offices to process pre authorizations for medications of Medicaid recipients. Processed incoming faxes through the pre authorization for Medicaid. Contacted doctor’s offices for information needed/missing to process prior authorizations

Sonic Drive In San Antonio, Texas (09/2012 to 02/2014)

Carhop

Take, fill and deliver orders to cars; Handle cash and credit card transactions; Make soft drinks, shakes, sundaes, banana splits, etc. Maintain cleanliness of property inside and out

The Children’s Shelter San Antonio, Texas (09/2009 to0 7/2011)

Administrative Assistant

Administrative Skills: record manager maintaining residents’ files,, copied records for Youth for Tomorrow Service Level reviews (quarterly),data entry into TIER; (photos of residents, caseworker contact) Customer Services Skills: answered phones, scheduled interviews, maintained volunteer log, sent correspondence to case workers/parents of upcoming treatment plan meetings

University of Texas Health Science Center San Antonio, Texas (12/2006 to 03/2008) Outpatient Clerk II

Administrative Skills: Scheduling appointments, records management, spending account management; data entry of record information into AdvancedMD Customer Service Skills: Greet customers, answered phones, faxed & copied documents, called in prescriptions

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