Cary E. Shearston Email & Phone Number

Commerce City, CO, US

Littleton, Colorado, United States

• Collaborated with healthcare providers and insurance companies to address billing issues and expedite payments.
• Respond to inquiries from insurance carriers via telephone, email, or fax, demonstrating a high level of customer service.
• Pursue reimbursement from carriers and patients through proactive communication, documenting all interactions in an electronic tracking system to ensure progress on outstanding accounts.
• Review Explanation of Benefits (EOBs) from assigned carriers and take appropriate action in line with company guidelines.
• Collect necessary information and prepare appeals to carriers for claim denials, ensuring timely and effective resolution.
• Analyze and identify patterns of denials and billing practices, performing complex account investigations to achieve resolution.

Lakewood, Colorado, United States - Remote

• Validated health benefit coverage, prior authorizations, and CPT codes to ensure accurate and timely processing of medical services.
• Received, reviewed, and coordinated all information necessary to process referrals for preauthorization, maintaining compliance with company standards.
• Communicated promptly with clinicians and members regarding urgent authorizations, denials, and requests for additional information, ensuring clarity and efficient resolution of issues.

Aurora, Colorado, United States

• Provided administrative and operational support for End Stage Renal Disease (ESRD) Acute and Home Dialysis programs, ensuring efficient patient care processes.
• Conducted patient procedure charge audits to maintain billing accuracy and compliance.
• Served as the staff schedule administrator, managing and auditing schedules to optimize workflow and staff availability.
• Performed audits, trend analyses, and forecasts of patient demand using Excel to support operational decision-making.
• Prepared report presentations that included charts and pivot tables to effectively communicate findings to management.
• Managed insurance eligibility and treatment authorization processes, facilitating timely patient care.

Aurora, Colorado, United States

• Provide prompt response to inquiries from patients, guarantors, or third-party payers.
• Review patient face sheets, dates and codes for accuracy prior to billing.
• Accounts receivables on unpaid accounts referring to aging’s or EOB's to correct, re-bill or confirm reason for unpaid balance.
• Communicate with patients and insurance carriers regarding payment policies and financial obligations for healthcare services.

Aurora, Colorado, United States

• Provide guidance regarding government payers, managed care, commercial and public insurances.
• Responsible for ensuring proper authorization, payment and coverage are applied per outpatient referral.
• Reviews complex referrals for completeness and follows up for additional information if necessary.
• EPIC Support Team, University IS and outpatient department liaison.
• Contributed to streamlining the hospital computer systems and referral process.
• TriWest web portal SME who provided training to new users.

Pheonix, AZ / Denver, CO

• Answered inbound provider calls nationwide for subscribers of TriWest from Colorado, Montana and Wyoming.
• Provided up to date benefit quotes stating copay, deductible, coinsurance, and out of pocket values for specific medical procedures.
• Researched CPT codes for various medical procedures giving the accurate benefit quote and supporting medical policies that may influence medical claim approval.
• Forwarded claims to appropriate departments for review and adjustment when claim denial errors are discovered.
• Explained provider offsets/refunds to providers when payments are recouped for claims paid in error.

Tucson, Arizona, United States

Tucson, Arizona, United States

Bachelor Of Arts - Ba, Organizational Management

cum laude

Bachelor Of Arts - Ba, Criminal And Social Justice