Shanekka H.

Experience

• 

  Medical Staffing Solutions, LLC

  Mar 2010 - Oct 2013

  Medicare Medical Billing Account Representative

  • Medical Billing claims account management. Using cloud-based accounting system Office Ally process all daily patient medical claims to public medical insurance carriers Medicare, Medicare Advantage HMO, Senior PPO plans and all commercial health insurance carriers under fee for service contracts rates using ICD 09, CPT and CMS HCPS codes. • Download Electronic funds transfer receipts along with corresponding Remittance advice copy on PDF to secure drive and print out for reconciliation. • Post daily receivables, reconcile payments and monitor reimbursement rates on medical service line items rates against fee for service contract rates. • Resubmit for additional payment on non-paid or underpaid services line items. Generate monthly account receivables reports.• Review patient EHR records for missed billable service revenue report to medical director findings for medical necessity and generate claims using service codes Show less

• 

  Xtend Healthcare, LLC

  Feb 2013 - Jan 2016

  Revenue Cycle Consultant 100% travel

  • Reconcile balances of AR accounts on a monthly basis• Meets daily, weekly, and month end deadlines including collection targets.• Collection follow-up internally or directly with vendors, clients & provider reps.• Perform review of "back office" Accounts Receivable and Accounts Payable reports. • Ensures compliance, reconciliation and review is completed entirely, timely and accurately.• Analyze and observe AR functions and processes in the business office to ensure maximum workflow and productivity, communicating deficiencies as well as best practices to operation management.• Assist, monitor and provide corrective action to accounts receivable workflow processes at assigned onsite locations. Show less

• 

  Augusta University Health

  Nov 2016 - now

  • Oversees all day-to-day management of the collections staff• Provide education, coaching, mentoring, monitoring, evaluating, and utilization of progressive discipline as required.• Provide monthly reporting to the director of insurance follow-up and collections.• Analyze payer data to determine trends and issues and report issue identified to senior leadership.• Present detailed Reports and a PowerPoint presentation of root cause analysis monthly.• Preform denial root cause analysis on trends identified and put processes in place to prevent denials • Cultivate and maintain cross-functional relationships with Admissions, Patient Accounting, HIMs and Finance, Case Management, Utilization Review departments and Insurance Provider Representatives.• Responsible for assisting the trainer at AU medical Center create new training materials for the department.• Research contract terms/interpretation and compile necessary supporting documentation for appeals, Terms & Conditions, and referral to refund unit on overpayments.• Establish departmental goals with the staff to optimize performance and meet cash goals while improving operations to increase patient satisfaction.• Review, update and implement policies and procedures.• Manage Collection specialist in Central Business office and remote staff.• Assist in strategic planning and perform ongoing process improvement evaluation. Show less • Responsible for the day to day workflow and supervision of the Denials/Appeals Specialist and Payment variance specialist.• Obtains a thorough understanding of payer reimbursement practices, procedures, and guidelines.• Manages work queues to ensure proper allocation of work among staff, and to identify required work queue changes.• Coordinates with Patient Accounts to correct all work queue issues.• Leverage advanced knowledge and understanding of ICD-9, ICD-10, HCPCS, DRG, APG, APC, and revenue code structures to analyze, manage, and adjust claim payments.• Responsible for communicating changes to staff for incorporation into the appeals process • Ensured assigned employees are trained and consistently follow all Team Health policies and procedures including applicable HIPPAA and Compliance Polices• Identifies issues with existing processes and initiates process improvement. Show less

  • CBO Manager of Denials and Collections

    Apr 2018 - now

  • Patient Accounting Denials Management/ Payment Variance supervisor

    Nov 2016 - May 2018
• 

  Wellstar Health System

  Nov 2024 - now

  Denials and Appeals Manager

  • Managed denials and appeals process, ensuring timely resolution for revenue recovery.• Analyzed denial trends, implemented strategies to reduce preventable denials, and improve payer reimbursement.• Collaborated with internal teams and payers to resolve underpayments and complex appeal cases.• Provided reporting and performance metrics to leadership for process improvement.