Billing Specialist

LETITIA SHELTON

**** *********** ***, *******,**, 37013, 615-***-****, **********@*****.***

OBJECTIVE

Excellent team player with 10 + years of Healthcare experience, 4 years of Assistant Managerial experience and 1 year of Team Lead experience. I have a BS degree in Health Information Management, Medical Assistant experience and I have a certificate in medical billing and coding. I am a hard worker and very knowledgeable about company policies and procedures. My goal is to use my skills that I have obtained working in the Healthcare industry and become an asset to a company that has the potential for growth.

EXPERIENCE

4/27/2009 TO 4/9/2012

Simplex Healthcare Franklin, TN

COLLECTIONS/BILLING SPECIALIST

• Process claims for Medicare Part B coverage for Diabetic testing supplies.

• Follow-up on medical claim status, billing and re-billing of claims, credit balances, aged accounts, denials and document payer and patient accounts on a daily basis.

• Verify eligibility for customers through Emdeon and Passport.

• View HCFA 1500’s to make sure they are coded correctly with ICD-9 codes and modifiers.

• Report audit findings and complaints to the Chief Compliance Officer.

9/24/2007 TO 4/24/2009

American Home Patient/DME Nashville, TN

QUALITY ASSURANCE SPECIALIST

• Performed Quality Assurance to Medicare physician orders, insurance deductibles, HCPC codes and co pays for accuracy and completeness to assure all Medicare requirements and polices were met for CPAP supplies.

• Audited orders that customers placed with Customer Service Representatives, to determine if all documentation for CPAP supplies were required and completed accurately.

• Corrected orders that were returned with supporting documentation to the billing department. Documentation was returned in a timely manner for training purpose.

11/21/2005 TO 9/14/2007

Concentra Integrated Services Franklin, TN

ANALYST/PROVIDER BILL REVIEW

• Audited claims for Workmen’s Compensation which involved claims for Chiropractic, Dental, Surgery, Anesthesia, Physical Therapy and DME/ Homecare.

• Reduced charges to PPO contracted rates through affiliated PPO networks.

• Customized utilization parameters based on dollar amount, CPT and ICD-9 code ranges, duration of care, frequency of visits and provider degrees.

11/11/1997 TO 11/7/2005

CIGNA Healthcare Franklin, TN

FACILITY ADMINISTRATOR/TEAM LEADER

• Coded and performed billing practices and processed Facility contracts for different Health Plans.

• Entered CPT codes, DRGs, HCPCs and match codes into CIGNA claim systems.

• Created, trained and documented policies and procedures for Health Plans that also entailed standard operating procedures for the department.

• Assisted Manager with day-to-day management of the work effort as a Team Leader over 22 employees.

• Used Quality Assurance skills to track, monitor and support the evaluation of employee performance and identify opportunities for improvement.

EDUCATION

AUG/1993 TO MAY/1997 Tennessee State University Nashville, TN

B.S. * HEALTH INFORMATION MANAGEMENT

• Healthcare Billing

• Healthcare Research

• Human Resource Management

• Management Information Systems

• Pharmacology

• CPT Coding

Professional Development:

Veterans Administration-Murfreesboro, TN

JAN/2005 TO DEC/2005 High Tech Institute Nashville, TN

MA DIPLOMA* ASSOCIATE OF APPLIED SCIENCE

• Cardiopulmonary/ECG

• Laboratory Clinical Procedures

• Office Administration

• Medical Office Supervisor

• Bookkeeping

Professional Development:

Tennessee Urgent Care-Smyrna, TN

TENNESSEE TECHNOLOGY Murfreesboro, TN

Medical Coding*Certificate

Skills

• MS Word, MS Excel and MS Outlook

• Customer Service

• Office Management

• HIPAA Compliant

• Medicare/Medicaid

• Billing/Collections

• Clinical Procedures

REFERENCES

References are available on request.

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