Candance Sherrer has over 15 years of experience in medical billing, coding, and customer service. She has skills in Microsoft Office, medical terminology, 10-key calculator, and various medical billing software. Her experience includes billing specialist roles at TriHealth and Oncology Hematology Care, where she submitted medical claims, processed payments, and followed up on denials. She also has experience providing customer service and working on accounts receivable as well as credentialing providers to ensure correct billing and payments.

1. Candance Sherrer
513-446-2933
Candancesherrer21@gmail.com
SKILLS
- Microsoft Word, Excel, Access, PowerPoint - Medical Terminology
- 10-Key Calculator, Data Entry - Health Care Benefits
- SAP, CAS,ASO/400,EPIC,NPI Registry,Q
NXT,NexGen,Agility
- Principle/Compliance Law s
- CCP, CCP2, CPT-codes - UB92, HCFA1500 or CMS1500
- Mainframe - IPD
- Lotus Notes Spreadsheets - Correspondence & MetaVance
- EHub - Certificate Search
- CampusVue - Facets
- Insystems - Call Center/Customer Service
BWC Bureau of Workers’Compensation
- Collections
EXPERIENCE
TriHealth Corporate Health/Occupational Medicine (Non clinic Corp. Health CincinnatiOH 12/15-Present
Account Billing Specialist
 Bill and correct Workers’Compensation claims.
 Follow up on denied claims and resubmit w ith correct correction to MCO
 Follow up on delinquent accounts 91-121 days past due.
 Take credit payments for delinquent accounts and self pay account and post incoming payments
 Post and take collection payment frompatients and employees.
 Call and send emails on delinquent accounts to obtain payment.
 Fax and receive inbound calls for payments and requesting past due invoices.
Oncology Hematology Care (Contract), Cincinnati, OH 3/15-11/2015
Patient Account Billing Medicare, Medicaid OH, KY and Indiana Only)
 Professionally answer incoming telephone calls frompatients/family members and commercial (all payees)
insurance companies.
 Provides information and resolves issues.
 Receives payment information on outstanding balances.
 Retrieves and completes follow -up on all assigned claims and correspondence based upon payersdenial.
 Sends patient correspondence on outstanding balances. Conduct phone/face interviewsto help determine if
they are eligible for financialassistance programs thru the hospital.
 Re-files claims to payers w hen not received or processed.
 Process/Retrieves and sends to payer’s information necessaryfor claimprocessing/payment in EPIC.
 Verify and update patient eligibility and benefits information frominsurance companies.
 Obtained prior authorizations for out of netw orkand specialty services checkeligibility via phone/ insurance
w ebsite to see if services and or patient w as covered,
 Thoroughly documents all pertinent patient and claim information in practice management software.
 Works w ith Lead, Management, and others to appeal claim denials.
 Enters charges into practice management systemand billing software.
 Completes all necessaryforms forbilling and files claims.
 Coordinates spend-down requirements forMedicaid.
 Managed accounts A-Mbased upon patients last name
Provider Entry Specialist (Tri-Health)
 Update provider demographic information and make sure correct credentialing info is entered into database to
ensure payments are being issued to correct Tax Id and NPI #.
 Ensure providers are credentialed if not send proper documentation to provider to get them credentialed in
timely manner.
 Update provider contracts to ensure they are paying correctly per contract.
 Update provider contracts per diem rates and fee schedules
 Mail correspondence to providers in order to notify them of NPI renew aland process.
 Carryout any other duties assigned by supervisor

2. Government CollectionsMedicaid/Medicare Analyst (OH, KY,IL,) (Parallon)
 Monitor hospitalinsurance claims by running appropriate reports and contacting insurance companies to
resolve claims that are not paid in timely manner.
 Identify coding or billing problems from EOBs and w orkto correct the errors in a timely manner.
 Obtained pre-authorizations if necessary to get claims paid and checkpatients eligibility via phone/insurance
w ebsite
 Identify problem accounts and escalate as appropriate.
 Update the patients account record to identify actions taken on account.
 Work w ith patients and guarantors to secure payment on outstanding account balance.
 Sort and file correspondence.
 Other duties as assigned.
Medical Recovery (Contract), Cincinnati, OH 01/14 - 09/14
Billing/Customer Service Coordinator
 Researched, process and pay specialty physician/hospitalclaims (all insurance payees, Medicaid (OH) and
Medicare) and commercial.
 Check patient eligibility via phone/ insurance w ebsite and update insurance info in system.
 Ensured claims w here being paid correctly according to provider contractsand fee/schedule.
 Checked provider’s credentialand demographic information to ensure they w ereactive and update.
 Conducted outgoing/ingoing calls to and fromHumana to get eligibility and claim information and to patients.
 Inputted patients insurance and update demographic information.
 Emailed and fax documentations needed to designated area.
 Mailed Humana reconsideration / appeal letters w ith necessarymedicalrecords and obtained back dated pre-
authorizations. Monitored appeals and considerate appeals on all levels
 Worked out of severaldatabases using dualmonitors.
 Assisted with any billing questions related to claims processing
 Managed accounts M-Z based upon patients last name (Payee Humana)

Skilled Care Pharmacy (Contract), Mason, OH 06/12 - 11/13
Medical Returns Creditsand Census Coordinator
 Issued returns and process credits
 Helped prepare census reports to complete billing.
 Processed Medicare Part D new and rejected Pharmacy claims for Home Health and Hospice patients in long
term nursing facility.
 Call insurance companies to verity coverage and patient information, update and add patients insurance.
 Obtained Prior authorizations fromvarious provider’s officesforspecialty drugs.
 Inbound/Outbound calls to and from facilities and patients.
Humana, Louisville, KY 06/05 - 03/10
Provider Network Operations (Team Lead)
 Reprocessedand made adjustments to commercial (hospital, dental, vision,DMEphysician, Medicare
and Medicaid)claims that had been resubmitted by providers.
 Worked froman Excel spreadsheet in w hich Iupdated and inputted all corrected information.
 Conducted intensive research in order to make sure that I w as successfulcompleting each project and paying
each claim correctly.
 Checked provider’s credentialand demographic information to ensure they w ereactive and update.
 Ensured claims w here being paid correctly according to provider contractsand fee/schedule.
 Collections recap monies if overpayments w here made against insurance claims.
 Customer Service inbound/outbound calls to physicians and members to recoup overpayments.
 Updated provider demographic information and make sure correct credentialing info is entered into database to
ensure payments are being issued to correct Tax Id and NPI #.
 Ensure providers are credentialed if not send proper documentation in timely manner.
 Updated provider contracts to ensure they are paying correctly per contract.
 Updated provider contracts per diem rates and fee schedules
 Mailed correspondence to providers in order to notify them of NPI renew aland process.
Grievance and AppealsSpecialist exclusively
 Respond to complaints, grievances and appeals on all levels in a consistent fashion, adhering to all regulatory,
accreditation and internal processing timelines and guidelines.
 Collect, analyze and interpret trend information to address and resolve non-routine business-related concerns.

3.  Build Humana’s brand image w ith employers, members, brokers, consultants, physicians, hospitals, regulators
and legislators by providing effective and efficient service.
CoordinationBenefit Commercial Claims
 Received and processed secondary commercial(hospital, DME, physician, Medicare and Medicaid) insurance
claims.
 Researched member’s benefits to ensure accuracy and accordance with levelof benefits.
 Review ed edits and researched themin the Mentor Database in order to pay claims in a timely and accurately
manner.
 Researched member’s benefits to ensure accuracy and accordance with levelof benefits. ASO(certified) and
Dental trained.
EDUCATION
Kentucky State University, Frankfort, KY, 2004
Bachelors in BusinessAdministration/ Management
References Available upon request