SBShirley Bailey
@shirleybailey
Experienced medical billing and coding specialist with leadership skills.
United StatesWhat I'm looking for
With over 7 years of experience in medical billing and coding, I have honed my skills in various healthcare settings, including multi-specialty clinics and outpatient facilities. My expertise encompasses coding for health encounters, E&M coding, and a deep understanding of medical terminology and human anatomy. I am well-versed in the complex federal regulations from the Centers for Medicare and Medicaid Services (CMS), ensuring compliance and accuracy in all processes.
In my recent role as a Subject Matter Expert and Team Lead at BroadPath Healthcare Solutions, I successfully managed and developed a team of ten, focusing on enhancing performance and resolving issues proactively. My experience as a Medicaid Claims Analyst further solidified my ability to review claims for accuracy, evaluate coverage, and identify potential fraud. I am dedicated to improving outcomes and ensuring that all claims are processed efficiently and accurately.
Experience
Work history, roles, and key accomplishments
SME-Subject Matter Expert /Team Lead
BroadPath Healthcare Solutions
Feb 2024 - Present (1 year 4 months)
Collaborated with supervisors to manage, develop, and coach a team of ten people. Prepared daily production reports and proactively identified potential issues, initiating solutions.
Medicaid Claims Analyst
BroadPath Healthcare Solutions
Jun 2021 - Present (4 years)
Reviewed claims for billing, coding accuracy, and completeness, determining coverage according to guidelines. Evaluated claims for and reported suspected fraud, waste, and abuse.
Claims Analyst
Anthem Blue Cross Blue Shield
Nov 2018 - Present (6 years 7 months)
Coded and processed claim forms for payment, ensuring all information was supplied before eligible payments were made. Researched and analyzed claims issues.
Coder I / Charge Entry Specialist
LifePoint Health
Mar 2015 - Present (10 years 3 months)
Processed E/M coding for Multi-Specialty Clinic, identifying diagnoses and procedures to assign proper ICD-10 CM and CPT codes. Initiated contact with medical staff to clarify discrepancies.
Education
Degrees, certifications, and relevant coursework
PGPurdue University Global
Bachelor of Science, Health Care Administration
Completed a Bachelor of Science degree with a focus on healthcare administration. Gained knowledge in managing healthcare systems and operations.
KUKaplan University
Certificate, Medical Billing & Coding
Obtained a certificate in Medical Billing & Coding. Developed expertise in medical terminology, coding standards (ICD-10-CM/PCS, CPT, HCPCS), and claims processing.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
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