Healthcare Revenue Cycle & Cash Application Professional

SHENETHEA DERONCELLEY

Miami, FL 786-***-**** *********@*****.***

PROFESSIONAL SUMMARY

Healthcare revenue cycle and financial operations professional with extensive experience in medical claims, claims auditing, medical billing, insurance verification, prior authorization, patient financial services, accounts receivable, cash application, reconciliation, and supervisory support. Experienced with high-volume workflows, claim and payment discrepancy resolution, quality review, reporting, staff training, HIPAA compliance, and cross-functional customer service. Working knowledge of UB-04, CMS-1500, ICD-9/ICD-10, CPT, HCPCS, Medicare, Medicaid, TPA, PPO, HMO, POS, FFS, DRG, COB, commercial, self-funded, international, self-pay, supplemental, PSN, and CMS network programs.

CORE SKILLS

Medical Claims Processing; Claims Examination and Adjustment; Claims Auditing; Denials and Appeals; Revenue Cycle Management; Medical Billing and Coding; Insurance Verification; Prior Authorization and Pre-Certification; Patient Financial Services; Accounts Receivable; Cash Application and Payment Posting; ACH, Wire, Check and Credit Card Processing; Payment Reconciliation; Remittance Research; Underpayment and Overpayment Resolution; Month-End Close; Quality Assurance; Audit and Compliance; HIPAA; Staff Training and Supervision; Customer Service; Data Entry; Reporting and Analysis; Process Improvement

PROFESSIONAL EXPERIENCE

AZAAKI LLC (WorldPAC) - Contractor 06/2024 - 08/2026

Cash Application / Accounts Receivable

• Applied incoming checks, ACH payments, wire transfers, and credit card payments to customer accounts and invoices accurately and timely.

• Matched payments to remittance documentation and allocated funds to open accounts receivable balances.

• Researched and resolved unidentified, unapplied, and misapplied payments and other account discrepancies.

• Maintained daily cash reports, reconciled cash receipts and bank activity, and supported month-end cash reporting.

• Partnered with billing, collections, customer service, and customers to resolve payment application issues and obtain missing remittance information.

• Maintained complete documentation for audit and compliance purposes and identified opportunities to improve cash application efficiency.

Amerijet International Inc. 02/2022 - 09/2023

Senior Cash Posting Supervisor

• Directed daily cash receipt, posting, balancing, and reconciliation activities, including high-volume transactions processed in Microsoft Dynamics 365.

• Researched and resolved misapplied payments, underpayments, overpayments, and posting corrections to maintain accurate accounts receivable records.

• Performed quality audits, trained new and existing staff, monitored workload and productivity, and reported trends and operational issues to management.

• Collaborated with Revenue Cycle teams to maximize revenue, strengthen cash application processes, and support continuous improvement.

• Monitored accounts receivable remittance activity, coordinated supporting documentation with collectors, managed posting deadlines, and participated in month-end close.

• Used Microsoft Excel for analysis and reporting while maintaining compliance with applicable policies and procedures.

Amerijet International Inc. 02/2006 - 02/2022

Cash Billing Analyst

• Processed and analyzed high-dollar, aggregate, domestic, stop-loss, excess-risk, and reinsurance claims with emphasis on loss control and managed care.

• Evaluated claims submitted by Third Party Administrators for self-funded clients to ensure compliance with policy provisions, regulatory guidelines, and industry standards.

• Responded to inquiries from Sales, TPAs, and groups regarding premiums, claims, excess-risk, and reinsurance matters.

• Approved claim payments on behalf of multiple clients and provided claim analysis, client support, and coordination with internal departments.

• Assisted in developing and revising client service procedures and protocols while maintaining strong client relationships.

• Analyzed claim losses and emerging issues, communicated findings to management, and worked with sales, marketing, and underwriting teams.

Strategic Health Development Corporation 11/2003 - 12/2005

Claim Adjuster / Auditor Coordinator Specialist Supervisor

• Supervised and supported claims adjusters, auditors, and coordination staff.

• Reviewed medical claims for accuracy, eligibility, coding, documentation, and proper reimbursement.

• Investigated denied, underpaid, overpaid, and disputed claims and coordinated timely resolution.

• Performed claims audits to identify billing errors, payment discrepancies, compliance concerns, and process weaknesses.

• Assigned workloads, monitored productivity, and ensured claims were completed within established deadlines.

• Trained employees on claims procedures, insurance requirements, auditing standards, and company policies.

• Communicated with insurance carriers, healthcare providers, patients, and internal departments regarding claim status and required documentation.

• Prepared reports on claim trends, denials, recoveries, audit findings, and employee performance.

• Improved procedures to increase accuracy, efficiency, and regulatory compliance.

• Maintained confidentiality of patient and company information in accordance with HIPAA and organizational standards.

• Supported management with escalated claims, special projects, and operational decisions.

ADDITIONAL HEALTHCARE AND ADMINISTRATIVE EXPERIENCE

North Dade Health Center 03/2004 - 06/2005

Patient Finance Associate Specialist

• Registered patients and obtained accurate demographic, insurance, and financial information at the workstation and bedside.

• Used mobile workstations to search the Master Patient Index (MPI) and assign the correct medical record number.

• Verified insurance coverage, obtained pre-certification and authorization for services, and secured appropriate treatment codes from insurance carriers.

• Calculated and collected patient-responsible amounts, explained collection policies, and processed patient payments.

• Obtained required signatures, scanned identification and insurance cards, and maintained complete documentation.

• Answered patient questions, explained financial requirements, assisted with appointment scheduling, and maintained accurate and secure patient records.

HEALTHSOUTH 05/2003 - 03/2004

Senior Insurance Verifier

• Verified insurance coverage, plan type, effective dates, deductibles, coinsurance, prior authorization requirements, and out-of-pocket maximums.

• Identified services requiring prior authorization, submitted requests, followed up on approvals and denials, and documented payer communications.

• Explained insurance coverage and estimated patient financial responsibility and addressed billing and insurance inquiries.

• Updated EMR/EHR and payer notes with eligibility results, authorization numbers, insurance changes, and supporting documentation.

• Coordinated with clinical staff, billing teams, and insurance payers to ensure required documentation and authorizations were complete and timely.

• Maintained compliance with HIPAA and applicable accreditation and regulatory standards.

CHCS 05/1999 - 04/2003

Senior Claims Examiner & Payroll Accounts Payable Specialist

• Administered health plan contracts and processed medical claims in accordance with plan guidelines and requirements.

• Reviewed and validated claim documentation and investigator findings and adjusted claims as necessary.

• Processed third-party liability, out-of-pocket maximum, and EDI reject requests.

• Interpreted insurance policies, claims procedures, and applicable legal and regulatory requirements.

• Resolved claim disputes and provided customer service for claim-related inquiries.

• Managed accounts payable activities including invoice verification, payment processing, account reconciliation, vendor records, and multi-currency transactions.

• Prepared monthly account statements and financial reports and maintained compliance with internal controls and applicable tax requirements.

• Resolved supplier and invoice inquiries, supported payroll-related disbursements, process improvements, and employee training.

Sheridan Health Corp 10/1998 - 05/1999

Data Entry - Medical Billing

• Entered and updated patient demographics, insurance information, treatment plans, test results, and billing data in EHR and billing systems.

• Supported medical billing and claim processing, verified insurance eligibility, and reviewed coding information for reimbursement accuracy.

• Maintained complete and accurate patient records in accordance with HIPAA and organizational privacy requirements.

• Identified and corrected data discrepancies and incomplete information to prevent billing delays.

• Collaborated with billing, clinical, and administrative teams to maintain data integrity and efficient operations.

Productivity Point International, Inc. 03/1998 - 10/1998

Data Entry Administrator

• Entered and updated customer, transactional, and operational data in CRM, ERP, and proprietary database systems.

• Verified and reconciled system entries against source documents, including invoices, forms, and scanned records.

• Performed data cleansing and deduplication and standardized customer, vendor, product, and account data.

• Maintained master data files, reference tables, data backups, and electronic and physical documentation.

Southeast Medical Financial System, Inc., Miami, FL 03/1994 - 03/1998

Medical Biller

• Prepared, submitted, and tracked medical claims to insurance carriers and patients to support timely reimbursement.

• Verified insurance coverage and eligibility before services were rendered.

• Reviewed clinical documentation for accurate coding of procedures, treatments, and diagnoses using CPT, ICD, and other applicable coding systems.

• Researched and resolved billing discrepancies, claim denials, and unpaid or outstanding claims.

• Generated patient invoices, posted payments to accounts receivable, and maintained remittance and account records.

• Communicated with patients, healthcare providers, and insurance companies to resolve billing and claim-related issues.

• Monitored denial and recovery trends to identify recurring issues and support billing performance improvement.

CERTIFICATIONS

Medical Secretary Certification Health Record Technician Certification Medical Billing Certification

TECHNICAL SKILLS

Microsoft Excel, Word, Access, PowerPoint, Outlook, SharePoint, Office 365, Microsoft Dynamics 365, QuickBooks, FoxPro, Exchange, ACCPAC Audit Access Database, AS400, PuTTY, Skype, Zoom, EMR/EHR systems, CRM/ERP systems, and proprietary claims and billing systems.

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