Shandra O Mebane
Greenville
Overview
8
8
years of professional experience
Work History
Billing Specialist
Healthcare Integrity Revenue Solutions
01.2022 - 08.2025
- Managed follow-up on unpaid claims and denials.
- Coordinated with patients to explain billing statements clearly while working in a call center environment.
- Submitted appeals to insurance companies when necessary.
- Identified trends in denied claims and worked with staff members to develop corrective action plans.
- Provided timely follow-up on unpaid claims to ensure prompt resolution of issues causing delays in reimbursement.
- Reviewed insurance claims for accuracy and completeness, ensuring that all required information was present.
Authorization Specialist II
Centene
12.2020 - 01.2022
- Supported the prior authorization request process to ensure that all authorization requests were addressed properly in the contractual timeline
- Supported utilization management team to document authorization requests and obtained accurate and timely documentation for services related to the members healthcare eligibility and access
- Verified member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment
- Performed data entry to maintain and update various authorization requests into utilization management system
Case Manager
MMC Group
08.2019 - 12.2020
- Made approval and denial determinations for support programs such as Copay, Patient Assistance Program, and Medicaid
- Triaged medications to be filled with specialty and non-specialty pharmacies
- Provided customer service while following up on missing information and prior authorizations
- Updated patient information and records to process submitted medical claims
- Streamlined insurance verification process, reducing claim denials and enhancing patient assistance program eligibility determinations
- Optimized claims resolution, significantly reducing underpayments and improving financial outcomes for both patients and the organization.
- Completed patient adherence activities that may include notification of upcoming refills, coordination, tracking, and confirmation of prescription delivery.
- Documented and processed Adverse Drug Events reports, contributing to improved patient safety protocols.
- Fostered strong relationships with insurance providers, expediting benefit verifications and enhancing overall patient care coordination.
Claims Processor
Recruiting Solutions
06.2017 - 07.2019
- Processed complex claims with a high degree of accuracy
- Verified insurance benefits for inpatient and outpatient services
- Reviewed claim submissions and processed as an approval or denial according to company policies and procedure
- Determined errors and reasons for denial and made corrections during the appeals process
- Processed complex claims with high accuracy, leveraging EHR systems to determine coding errors based on Medicare and Medicaid guidelines.
- Managed medical record systems including Epic, OPS, Cerner, and Athenahealth, and NextGen ensuring precise tracking and billing updates for efficient claim processing.
- Coordinated benefits information with patients, providing clear explanations and guidance to enhance understanding of claim processes.
- Expertly navigated EHR systems to process complex claims, ensuring accuracy and compliance with Medicare and Medicaid guidelines.
Education
BA - English
NC Agricultural & Technical State University
Greensboro, NC01.2002
Skills
- CRCR Certified
- Authorization processing
- Claims processing
- Medical coding
- Customer service
- Data entry
- Medical terminology
- Insurance verification
- Electronic Health Records
- Medical scheduling
- Utilization review
- Insurance claim processing
- HIPAA compliance
References
References available upon request.
Timeline
Billing Specialist
Healthcare Integrity Revenue Solutions
01.2022 - 08.2025
Authorization Specialist II
Centene
12.2020 - 01.2022
Case Manager
MMC Group
08.2019 - 12.2020
Claims Processor
Recruiting Solutions
06.2017 - 07.2019
BA - English
NC Agricultural & Technical State University