Medical Office Administration & Insurance Billing and Coding Certificate Program

Surf

Family time and beach walks.  i have always enjoyed sewing and fabric arts

Stitching and mixed media art.  i have a group of moms who i lunch with once a month for the last 15 years and we enjoy sharing stories

Life experiences

Family life and support.

Medical Biller & Account Management

I have a full range of experience in all areas of Medical Office Administration from managing a practice, leading and training office staff, credentialing for providers, and understanding the accounts receivables and medical billing and coding. My strong customer service skills benefit in understanding the impact your front office can have on your practice since this is the point of initial contact and can actually make or break a practice. I spent many years working in Plastic Surgery offices and attending annual educational conferences which helped to refine my skills in plastic surgery office administration. Working in this specialty taught me the importance of marketing, making connections, and why and how your front office employees can influence how your patients see your practice. I enjoyed coordinating speaking events to help market a practice. I have managed surgery schedules and coordinated surgical teams with pre-operative patient follow through. I have the ability to multi-task in very busy practices and retain unique problem solving abilities. 

I am very passionate about the medical billing portion of the medical practice and enjoy keeping current with billing trends, researching educational articles to help gain optimal reimbursement for any practice I am billing for. I have experience with Medicare billing and most commercial insurance companies including understanding billing guidelines and maintaining compliance with contracting laws. I have experience with drafting appeal letters with positive results. I have worked for a small practice with a single provider to a medium-large size multi-provider practice. I have experience in billing for Mental Health, Chiropractic, Plastic Surgery, Dermatology, Anesthesia, ASC, Rheumatology. I enjoy working with like- minded positive individuals with similar interests and goals who care about the success of a growing company and enjoy working together to obtain great results.

I am primarily responsible for managing Dr. Monahan's accounts receivables and medical billing.  Recently I assisted with transitioning his practice to a new practice management program, after researching our options to become compliant with current PHI laws.  I formatted the entire program to fit Dr. Monahan's practice needs by assisting with transferring our patient demographic data, inserted all the CPT and ICD-9 codes for billing purposes and also scheduled office staff training.

Medical Billing & Accounts Receivables Management

I am responsible for all medical billing and claims follow up.  In addition, I review monthly aged claim reports and follow up as necessary.  I also send monthly statements & receipts to patients.  I have assisted Dr. Solomon in changing over to ERA & EFT's with all insurance companies he is contracted with.  I post all the ERA's weekly.  I enter all the patient demographic's and also verify their benefits.  In addition, I assist Dr. Solomon with keeping his CAQH status current, as well as his credentialing status with the insurance panels.

As the Senior Medical Biller for Coastal Psychiatric I was primarily responsible for the submission of all claims with accuracy and time efficiency within the required guidelines of our insurance panels for our large multi-group practice servicing over 400-500 patients weekly.  Maintaining and updating current billing procedures as it applied to the services offered and updating professional fee schedules for maximum reimbursements from various insurance companies was my responsibility. Posting all payments with accuracy. Follow up on claim denials & drafted appeal letters as necessary. Addressed requests from patients with insurance concerns with care and professionalism. Set up multiple insurance website accounts to use as a multi-resource tool for insurance information, verification, claims follow up & continued education.  Implemented electronic ERA's with our software vendor & multiple payers. Responsible for teaching, mentoring & educating billing staff within our department and checking work & offering guidance and instruction as learning progressed.

Senior Medical Biller

I assisted the Insurance Department Billing Lead with claims follow-up and appeal letters with positive results.  I would also get occasional requests to research and analyze A/R data and prepare my findings in a report for the business administrators.  I opened up website access to all the leading insurance companies to allow us the ability to find insurance data, claims status, and much more.

Independent Contractor- Insurance Department

I was primarily responsible for the full functioning of his front office, practice management, credentialing, updated office systems to comply with current HIPAA & PHI laws. In addition, I managed all the medical billing, updated the fee schedule, maintained the accounts receivables & prepared monthly billing statements. I researched and assisted with the transition to a new practice management program and was responsible for all the training, data transfer and formatting to fit the needs of the practice. I enjoyed helping with marketing and arranging speaking events. I assisted our many patients with questions about their insurance benefits. I opened up many provider accounts with all the leading insurance companies to allow our office the ability to find patient insurance benefit details, claim follow up & use as an educational resource. The medical billing ranged from billing Medicare, Auto Insurance claims & most leading commercial insurance companies.

Office Manager

Assist with all front office duties including scheduling appointment sessions for multiple providers, (25+) and assisting patients with any needs.  I was responsible for chart preparation, handling multiple busy phone lines, insurance verification, assisting providers with any needs such as calling in prescription refills, or any other concerns.  Coastal also recognized my interest in marketing and allowed me to market various mental health events we were planning in our office by visiting & contacting other nearby businesses.  I also began to help in the insurance department by calling and following up on pending claims.

Front Office Assistant

I was looking for a part time position where I could offer my experience and support.  I was hired to assist Dr. Cooper with his patients, his scheduling, assist in the exam rooms and wherever needed.  I also helped with very busy phone support, chart preparation and extra administrative support as needed.

Office Assistant-part time

Independent Business  Consultant

Office Assistant

Assist with the forming & development of his new medical practice.  Public relations, marketing, billing, scheduling.  Consult with doctor with marketing decisions and provided support.

I was primarily responsible for patient support, coordinating the surgery schedule, maintaining the appointment schedule, coordinating marketing events, collecting all fees in advance for cosmetic surgery procedures.  

Co Manager

Dr. Bucko was the Chief of Staff at Palomar-Pomorado Hospital at this time and I was the office liaison and assisted with his COS schedule.  I was also his Lead Medical Biller and billed for all reconstructive procedures and did necessary verifications, and follow up when needed.

Executive Office Assistant & Chief of Staff Liaison & Medical Billing Lead

I was responsible for Dr. Pousti's surgical schedule, collecting all money and reviewing the pre-op information with patients.  I also was responsible for coordinating marketing and speaking events.  I was the "team leader" in the office for all front office staff.

I was responsible for a very busy surgical schedule and appointment schedule and very busy multiple phone lines.  I also reviewed pre-operative instructions when scheduling surgery and answered any questions at the conclusion of the consultation.  I also did all the billing and follow up.  

Find out detailed information about Shelley Gaines, Medical Biller & Account Management in Carlsbad, CA

Shelley Gaines: Medical Biller & Account Management in Carlsbad, CA

Shelley Gaines

Michael Monahan, D.C.

Robert J. Solomon, M.D., Inc.

Coastal Psychiatric Medical Associates, Inc.

Coastal Psychiatric Medical Associates, Inc.

Michael Monahan, D.C.

Coastal Psychiatric Medical Associates, Inc.

Mark Andrews, M.D. & Matthew Cooper, M.D., Plastic & Reconstructive Surgery

Matthew Cooper, M.D., Plastic & Reconstructive Surgeon

Mark Andrews, M.D. & Matthew Cooper, M.D., Plastic & Reconstructive Surgery

Matthew Cooper, M.D., Plastic & Reconstructive Surgeon

David Wolf, M.D., Plastic & Reconstructive Surgery

David Wolf, M.D., Plastic & Reconstructive Surgery

C. Dennis Bucko, M.D., Plastic & Reconstructive Surgery

C. Dennis Bucko, M.D., Plastic & Reconstructive Surgery

Michael Pousti, M.D., Plastic & Reconstructive Surgery

Dennis K. Anderson, M.D., Plastic & Reconstructive Surgery

San Bernardino Valley College

San Bernardino Valley College

United Health Careers Institute

United Health Careers Institute