SHARON SUTTON
Portsmouth
Summary
Experienced Medical Billing Specialist with 15 years of success managing healthcare claims, insurance verification, and patient billing across Medicaid, Medicare, and commercial plans. Skilled in reducing denials, ensuring HIPAA compliance, and enhancing revenue cycle processes. Bachelor’s in Finance and experienced with platforms like Epower, Availity, and CollaborateMD. Open to remote opportunities.
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
14
14
years of professional experience
Work History
Medical Billing Specialist
PVD Management LLC
San Antonio
08.2017 - Current
- Process over 500 medical claims monthly, ensuring 98% accuracy and compliance with payer and regulatory guidelines for 2 freestanding emergency rooms and 2 urgent care facilities.
- Negotiate reasonable payments with insurance carriers, attorneys, patients, and third-party payors.
- Verify insurance eligibility, benefits, and authorizations for a diverse provider network.
- Resolve 85% of claim denials on first appeal, maintaining detailed documentation and achieving timely reimbursement.
- Collaborate with insurance companies and patients to address billing inquiries professionally.
- Utilize billing platforms such as Epower, CollaborateMD, and Availity.
Claims Processor / Sr Integrated Services Specialist
Aetna (formerly Coventry Healthcare)
San Antonio
07.2011 - 08.2017
- Selected as one of six employees to lead a system migration post-acquisition, ensuring seamless transition to Aetna policies and platforms.
- Trained new and existing employees on claims processing and customer service procedures.
- Handled high-volume inbound inquiries regarding insurance claims, billing, and policy coverage.
- Ensured accurate claim entry and quickly resolved billing discrepancies.
- Maintained high customer satisfaction through effective communication and resolution.
- Partnered with providers and members to clarify billing and coverage details.
Education
Bachelor of Science - Finance
Virginia Polytechnic Institute and State University
Blacksburg, VASkills
- Epower
- CollaborateMD
- Availity
- ICD-10
- CPT Coding
- Microsoft Office
- Excel
- Word
- Outlook
- Claims Submission
- Appeals
- Eligibility Verification
- Customer Service
- Conflict Resolution
- HIPAA Compliance
- Insurance verification
- Claim negotiation
- Billing compliance
- Claims processing
- Revenue cycle management
- Data analysis
- Quality assurance
- Problem solving
- Effective communication
- Quality-oriented team player
- Accounts payable
- Claim submission
- Denial management
- Payment posting
- CPT knowledge
- Commercial and private insurance
- Insurance claims processing
- Electronic health record software
- Data entry
Timeline
Medical Billing Specialist
PVD Management LLC
08.2017 - Current
Claims Processor / Sr Integrated Services Specialist
Aetna (formerly Coventry Healthcare)
07.2011 - 08.2017
Bachelor of Science - Finance
Virginia Polytechnic Institute and State University
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