Shirley Bailey Email & Phone Number

Tucson, Arizona, United States

 Working with company leadership to define project objectives, processes, policies, procedures and rules Explaining policy implementation to fellow team members Getting management approval or approving alterations in rules, procedures and policies Coach team members when needed Answer claims processing questions

Tucson, Arizona, United States

 Review claims for billing, coding accuracy and completeness Determines and understands the coverage provided under a member’s plan to determine if claims are payable according to EMI Health’s guidelines, policies and procedures Evaluate claims for and report out suspected fraud, waste, and abuse Use enterprise claims processing platform and ancillary supporting data bases and systems to research and/or retrieve key information necessary to support claims processing Production goals-150-170 claims per day Process 180-200 claims per day (medical, outpatient, inpatient, 1500 HFCA, UB-04) Processing of Coordination of Benefits COB), Medicare, Medicaid, Medicare Supplemental/Medicare Replacement claims, and UB forms Knowledge of medical and vision terminology, coding, and health insurance benefit plans Reviews electronic and paper insurance claim forms and related documents for completeness

Midland, Georgia

 Codes and processed claim forms for payment ensuring all information is supplied before eligible payments are made Researched and analyzed claims issues Reviewed, analyzed, and processed claims/policies related to events to determine extent of company's liability and entitlement Processed 60-65 (medical, dental and vision) claims for Commercial, Medicare, Medicaid, and supplemental insurance daily

Columbus, Georgia Area

Identified diagnoses and procedures, and assigned proper ICD-10 and CPT codes and billed insurance companyInitiated contact with medical staff when necessary to clarify discrepanciesContacted managers if medical charts were not available within 48 hours to ensure timely billing

Bachelor Of Science - Bs, Health/Health Care Administration/Management, 3.8

Activities and Societies: The National Society of Collegiate Scholars

Certificate, Medical Billing/Coding, 3.5