Summary
Work History
Education
Skills
Accomplishments
References
Timeline
Generic

Shawn Candelaria

Summerville

Summary

Seasoned Denial Specialist with solid experience in medical billing and insurance claims. Strong understanding of denial management processes, claim reviews, and appeals procedures. Demonstrated ability to work well under pressure while maintaining high attention to detail and accuracy. Proven record of improving efficiency within healthcare financial operations.

Work History

Hospital Denial Specialist in Billing Department

MUSC Medical University Hospital Authority
Charleston
07.2026 - Current
  • Reviewed denied claims for accuracy and compliance with hospital policies.
  • Assisted in gathering documentation to support appeal processes for denials.
  • Communicated with insurance companies to clarify denial reasons and requirements.
  • Updated claim status in the hospital's billing system for tracking purposes.
  • Maintained communication with providers regarding denied claims and appeals processes.
  • Responded promptly to customer inquiries about claim status or denied services.

Education

Associate - Graphic Design

Trident Technical College
Charleston, SC

Skills

  • Claims analysis
  • Medicare regulations
  • Denial management

Communication with insurance payers

Accomplishments

  • 2023 Productivity Power House 1st Place Appeals
  • 2024 Sparks Award -937 submitted with 379 overturned leading the total denial recovery of 1.8 million dollars
  • 2024 Outstanding Teamwork Award

References

References available upon request.

Timeline

Hospital Denial Specialist in Billing Department

MUSC Medical University Hospital Authority
07.2026 - Current

Associate - Graphic Design

Trident Technical College
Shawn Candelaria