Sheyla Gaddist
Summerville
Summary
Results-driven medical billing and coding professional with 7 years of experience in charge capture, medical claims, and benefit verification. Proficient in ICD-10 and CPT coding, with expertise in medical records management and insurance verification. Skilled in EMR systems, data entry, and Microsoft Office. Currently working remotely as a Charge Capture Specialist.
Overview
27
27
years of professional experience
Work History
Charge Capture Specialist
Optum 360 United Healthcare
Minnetonka
10.2021 - Current
- Ensured all billing charges were captured in an appropriate manner.
- Identified, analyzed and reconciled billing errors or omissions.
- Cross trained in A/R to assist in denials.
- Rebilled claims in the clearinghouse.
- Occasionally send actions to providers to assist in correcting missing charges, etc.
Medical Claims Specialist
Palmetto Primary Care Physicians
Summerville
10.2016 - 10.2021
- Responsible for reviewing claims for correct CPT codes, ICD 10 codes, and submitting to clearinghouse.
Benefit Verification Specialist
Palmetto Primary Care Physicians
Summerville
05.2012 - 10.2016
- Responsible for pre-certification and insurance verification prior to patients appointments;
- Obtained prior authorizations prior to scheduled appointments;
- Calculated patients estimated responsibility according to their benefits;
- Frequent phone and messaging to physicians for payable diagnosis codes that passed medical necessity edits for certain procedures.
Health Information Management Clerk
Trident Medical Center
North Charleston
04.2007 - 05.2012
- Responsible for the pulling of medical records for same day surgery schedules;
- Terminal digit filing;
- Assisted patients and other medical facilities in obtaining and/or releasing information from a patients chart;
- Filed transcribed reports within patients charts to the floors while still being inpatient;
- Secured patients medical records upon discharge from hospital.
Medical Records Specialist
Carolina Family Care
Charleston
11.2003 - 04.2007
- Pulled medical records for next day appointments;
- Filed loose reports within patients medical record;
- Answered phones;
- Retrieved messages from prescription line and forwarded to appropriate physician;
- Boxed and stored old medical records.
File Clerk
Columbia Staffing
North Charleston
02.2001 - 11.2003
- Most assignments were file clerk positions;
- Filing of loose material in patients medical record;
- Occasional pulling of medical records.
- Temporary staffing agency
Inspector/Returns Clerk
Donnkenney Apparel
Summerville
09.1998 - 09.1999
- Inspected returned garments for defects;
- Boxed and placed for storage in warehouse.
Education
Academic diploma -
Colleton County High School
Walterboro, SCSkills
- Communication skills
- CPT Coding
- Insurance verification
- Medical Records
- Electronic health records (EHR) management
- Phone etiquette
- Computer skills
- 10 key typing
- ICD coding
- Medical Billing
- Word processing
- E-clinical works
- Medical Office Experience
- Microsoft Outlook
- Revenue cycle management
- Multi-Line Phone System
- Records management
- Warehouse experience
- EMR systems
- Time management
- Managing patient records
- Phone communication
- Typing
- Data entry
- Organizational skills
Languages
English
Personal Information
- Authorized To Work: US for any employer
Timeline
Charge Capture Specialist
Optum 360 United Healthcare
10.2021 - Current
Medical Claims Specialist
Palmetto Primary Care Physicians
10.2016 - 10.2021
Benefit Verification Specialist
Palmetto Primary Care Physicians
05.2012 - 10.2016
Health Information Management Clerk
Trident Medical Center
04.2007 - 05.2012
Medical Records Specialist
Carolina Family Care
11.2003 - 04.2007
File Clerk
Columbia Staffing
02.2001 - 11.2003
Inspector/Returns Clerk
Donnkenney Apparel
09.1998 - 09.1999
Academic diploma -
Colleton County High School