1. Candance Sherrer
513-446-2933
Candancesherrer21@gmail.com
SKILLS
- Microsoft Word, Excel, Access, PowerPoint - Medical Terminology
- 10-Key Calculator, Data Entry - Health Care Benefits
- SAP, CAS,ASO/400,EPIC,NPI Registry,QNXT - Principle/Compliance Law s
- CCP, CCP2, CPT-codes - UB92, HCFA1500 or CMS1500
- Mainframe - IPD
- Lotus Notes Spreadsheets - Correspondence & MetaVance
- EHub - Certificate Search
- CampusVue - Facets
- Insystems - Call Center/Customer Service
- Collections
EXPERIENCE
Oncology Hematology Care (Contract), Cincinnati, OH 3/15-11/2015
Patient Account Billing Medicare, Medicaid OH, KY and Indiana Only)
 Professionally answer incoming telephone calls frompatients/family members and commercial (all payees)
insurance companies.
 Provides information and resolves issues.
 Receives payment information on outstanding balances.
 Retrieves and completes follow -up on all assigned claims and correspondence based upon payers denial.
 Sends patient correspondence on outstanding balances.
 Re-files claims to payers w hen not received or processed.
 Process/Retrieves and sends to payer’s information necessaryfor claimprocessing/payment in EPIC.
 Verify and update patient eligibility and benefits information frominsurance companies.
 Thoroughly documents all pertinent patient and claim information in practice management software.
 Works w ith Lead, Management, and others to appeal claim denials.
 Enters charges into practice management systemand billing software.
 Completes all necessaryforms forbilling and files claims.
 Coordinates spend-down requirements forMedicaid.
Provider Entry Specialist (Tri-Health)
 Update provider demographic information and make sure correct credentialing info is entered into database to
ensure payments are being issued to correct Tax Id and NPI #.
 Ensure providers are credentialed if not send proper documentation to provider to get them credentialed in
timely manner.
 Update provider contracts to ensure they are paying correctly per contract.
 Update provider contracts per diem rates and fee schedules
 Mail correspondence to providers in order to notify them of NPI renew aland process.
 Carryout any other duties assigned by supervisor
Government CollectionsMedicaid/Medicare Analyst (OH, KY,IL,) (Parallon)
 Monitor hospitalinsurance claims by running appropriate reports and contacting insurance companies to
resolve claims that are not paid in timely manner.
 Identify coding or billing problems from EOBs and w orkto correct the errors in a timely manner.
 Obtain pre-authorizations if necessary to get claims paid.
 Identify problem accounts and escalate as appropriate.
 Update the patients account record to identify actions taken on account.
 Work w ith patients and guarantors to secure payment on outstanding account balance.
 Sort and file correspondence.
 Other duties as assigned.
University Physicians Hospital (Contract), Cincinnati, OH 01/14 - 09/14
Billing/Customer Service Coordinator

2.  Researched, process and pay specialty physician/hospitalclaims (all insurance payees, Medicaid (OH) and
Medicare) and commercial.
 Ensured claims w here being paid correctly according to provider contractsand fee/schedule.
 Checked provider’s credentialand demographic information to ensure they w ereactive and update.
 Conducted outgoing/ingoing calls to and fromHumana to get eligibility and claim information and to patients.
 Inputted patients insurance and update demographic information.
 Emailed and fax documentations needed to designated area.
 Mailed Humana reconsideration / appeal letters w ith necessarymedicalrecords and obtained back dated pre-
authorizations. Monitored appeals and considerate appeals on all levels
 Worked out of severaldatabases using dualmonitors.
 Assisted with any billing questions related to claims processing
Skilled Care Pharmacy (Contract), Mason, OH 06/12 - 11/13
Medical Returns Creditsand Census Coordinator
 Issued returns and process credits
 Helped prepare census reports to complete billing.
 Processed Medicare Part D new and rejected Pharmacy claims for Home Health and Hospice patients in long
term nursing facility.
 Call insurance companies to verity coverage and patient information, update and add patients insurance.
 Obtained Prior authorizations fromvarious provider’s offices.
 Inbound/Outbound calls to and from facilities and patients.
Humana, Louisville, KY 06/05 - 03/10
Provider Network Operations (Team Lead)
 Reprocessed and made adjustments to commercial (hospital, dental, DME physician, Medicare and Medicaid)
claims that had been resubmitted by providers.
 Worked froman Excel spreadsheet in w hich Iupdated and inputted all corrected information.
 Conducted intensive research in order to make sure that I w as successfulcompleting each project and paying
each claim correctly.
 Checked provider’s credentialand demographic information to ensure they w ereactive and update.
 Ensured claims w here being paid correctly according to provider contractsand fee/schedule.
 Collections recap monies if overpayments w here made against insurance claims.
 Customer Service inbound/outbound calls to physicians and members to recoup overpayments.
 Updated provider demographic information and make sure correct credentialing info is entered into database to
ensure payments are being issued to correct Tax Id and NPI #.
 Ensure providers are credentialed if not send proper documentation in timely manner.
 Updated provider contracts to ensure they are paying correctly per contract.
 Updated provider contracts per diem rates and fee schedules
 Mailed correspondence to providers in order to notify them of NPI renew aland process.
Grievance and AppealsSpecialist
 Respond to complaints, grievances and appeals on all levels in a consistent fashion, adhering to all regulatory,
accreditation and internal processing timelines and guidelines.
 Collect, analyze and interpret trend information to address and resolve non-routine business-related concerns.
 Build Humana’s brand image w ith employers, members, brokers, consultants, physicians, hospitals, regulators
and legislators by providing effective and efficient service.
CoordinationBenefit Commercial Claims
 Received and processed secondary commercial(hospital, DME, physician, Medicare and Medicaid) insurance
claims.
 Researched member’s benefits to ensure accuracy and accordance with levelof benefits.
 Review ed edits and researched themin the Mentor Database in order to pay claims in a timely and accurately
manner.
 Researched member’s benefits to ensure accuracy and accordance with levelof benefits. ASO(certified) and
Dental trained.
EDUCATION
Kentucky State University, Frankfort, KY, 2004
Bachelors in BusinessAdministration/ Management
References Available upon request