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Shanita Moore

@shanitamoore

Managed Care Appeals Analyst at Elevate PFS, appealing denied claims and comparing reimbursement against contract terms.

United States

Message

What I'm looking for

I'm seeking an opportunity to leverage my expertise in revenue recovery, denial and appeals management, and medical and pharmacy rebate management to drive revenue performance and operational excellence.

At Elevate PFS, I coordinate payer denial and appeal activities, follow up on submitted appeals, and appeal denied claims. I also compare reimbursement findings with plan documentation, network agreements, and contract requirements.

At Optum, I processed pharmaceutical rebates under established contract terms, verified eligibility, and reconciled payments against billing invoices. I interpreted and redlined rebate agreements before implementation and coding in the rebate billing system.

As a Collections representative at optum360, I researched discrepancies affecting client accounts receivable, filed appeals in response to denials, and worked with internal and external contacts to resolve payment errors or underpayments.

At hca, I analyzed claims for possible overpayments, interpreted managed care contracts, and supported the revenue cycle by identifying underpayments and system errors. My background also includes healthcare revenue cycle, reimbursement, and payer insurance groups.

Experience

Work history, roles, and key accomplishments

Current

Managed Care Appeals Analyst

Current

Elevate PFS

Jan 2025 - Present (1 year 10 months)

Coordinate payor denial and appeal activities to ensure timely response from third party payors. Follow up on submitted appeals, appeal denied claims, and communicate denial trends with stakeholders.

Denial Management Appeals Claims Processing Payer Engagement Reimbursement Analysis

Rebate Management Specialist

Optum

Jan 2020 - Jan 2025 (5 years)

Processed pharmaceutical rebates based on contract terms, verified eligibility, audited billing reports, and reconciled payments. Interpreted contracts and identified system issues, enhancements, and testing needs.

Pharmaceutical Rebates Contract Interpretation Data Analysis Billing Reconciliations 340B Reporting

Managed Care Analyst

Bottom Line Systems

Feb 2011 - Feb 2012 (1 year)

Reviewed insurance contracts to understand payment methodologies, contacted insurance companies for underpaid claims, and submitted appeals to overturn denials. Provided quality customer service.

Contract Review Claims Appeals Customer Service Revenue Cycle Management

Overpayments Analyst

HCA

Jan 2005 - Dec 2010 (5 years 11 months)

Served as liaison between payers and facility for overpayment and refund requests. Analyzed claims for overpayments, interpreted managed care contracts, and processed refunds according to CIA guidelines.

Overpayment Identification Contract Interpretation Refunds SOX Compliance Data Analysis Reporting

Clinical Administrative Coordinator

Optum

Aug 2018 - Present (8 years 3 months)

Coordinated processing of admission and discharge information, verified and updated provider database, and routed incoming faxes and emails. Communicated with providers to update provider directory.

Medical Records Provider Database Communication Skills Documentation

Collections Representative

Optum360

Dec 2013 - Present (12 years 11 months)

Resolved discrepancies affecting client A/R, analyzed data to determine root cause, and initiated billing to primary, secondary, and tertiary payers. Filed appeals in response to denials and provided training to coworkers.

Accounts Receivable Billing Appeals Data Analysis Training Payer Engagement