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
Similar Profiles
Deepak PandeyDeepak Pandey
Client Service Manager at Integrity-healthcareIntegrity Healthcare Solutions Pvt LtdClient Service Manager at Integrity-healthcareIntegrity Healthcare Solutions Pvt Ltd
Anu PillaiAnu Pillai
Manager at Integrity Healthcare Solutions Pvt LtdManager at Integrity Healthcare Solutions Pvt Ltd
MOHIN BANVAMOHIN BANVA
A/R Process Associate at Integrity healthcare SolutionsA/R Process Associate at Integrity healthcare Solutions
Jonathan DiazJonathan Diaz
Warehouse Inventory Clerk at Encore WireWarehouse Inventory Clerk at Encore Wire
Kendrick LomaxKendrick Lomax
Production Associate at Magna Drive AutomotiveProduction Associate at Magna Drive Automotive