Summary
Overview
Work History
Education
Skills
Certification
Other Work Experience
Timeline
Generic

Sheila Camara

Rancho Cordova,CA

Summary

Proactive and goal-oriented professional with exceptional time management and problem-solving skills. Currently seeking a career path in Finance. Reputation for reliability and adaptability, combined with swift capacity to learn and apply new skills, sets me apart. Committed to leveraging these qualities to drive team success and contribute to organizational growth.

Overview

20
20
years of professional experience
1
1
Certification

Work History

Claims Coordinator – Remittance

OrthoFi
08.2021 - Current
  • Accurately post dental insurance payments, correspondences, adjustments, and denials to the correct practice and patient accounts
  • Identify interest payments, recoupments, and adjustments and correctly allocate the remittance
  • Locate missing EOBs via carrier site or contacting the carrier to request EOBs
  • Processing Virtual Credit Cards and allocating payment to the correct practice and patient accounts
  • Working with High Touch practices to ensure processing of payments are allocated correctly and to assist with reallocations
  • Communicate with High touch practice and claims to research missing payments
  • Work assigned projects such as audits for High Touch practices
  • Download work queue data via Tableau and sort remittance to various queues in Excel
  • Creating cases via Sales Force
  • Conducted Training for VCC and Unallocated processing
  • Created SOPs for VCC and Unallocated processing
  • Submit claims to carrier via Clearinghouse and by mail.
  • Analyzing patient accounts locating missing and/or late payments.
  • Contacting carriers for missing payment information.
  • Verify overpayment made by carrier and initiate a refund request to carrier.
  • Reviewing and correcting incorrect billing and resubmitting corrected claims.

Appeals Representative

Delta Dental of California
11.2018 - 09.2021
  • Research and responds directly to members and providers appeals
  • Reviews case to determine if sufficient records were obtained, and review Dental records and dental policies to determine if correct action for each case
  • Verify claims were processed in accordance to the processing policies and Group benefits
  • Research claims and communicate with the appropriate department for Corrective actions
  • Document all communication and maintain up to date status of cases
  • Responds to members and provider questions via e-mail, telephone, and Written inquiries
  • Prepares formal written responses to enrollees and dentists concerning Inquiries and complaints
  • Maintains complaint tracking record and daily turnaround time
  • Review patient account summary to determine overpayments made by Members and send correspondence to providers to issue refunds
  • Research and calculate refund amount and initiate withholding procedures
  • Answers telephone inquiries from enrollees and dentists regarding processing Polices, eligibility, breakdown of patient’s benefits, and procedure history
  • Performs miscellaneous duties as assigned

Claims Auditor

Delta Dental of California
09.2005 - 11.2018
  • Auditing of dental and orthodontic claims and adjusting incoming correspondence claims from provider
  • Research and reissuing unpaid checks, sending manual check requests to Finance department
  • Logging refund checks from providers to create cash receipt
  • Verifying amounts on refund checks and applying cash receipts to claims
  • Making necessary adjustments as needed
  • Knowledge of coordinating benefits from third party insurance carriers
  • Knowledge of benefits, deductibles, and maximums
  • Creating correspondence letters
  • Booking conference rooms for meetings, creating meeting agendas and taking minutes
  • Working on special projects assigned by supervisor and management
  • Create job aids to help teammates understand the process of processing orthodontic claims
  • Mentor teammates and assisting them to be efficient as auditors
  • Exceeding department standards of 98% quality and processing 17 claims per hour

Education

Bachelors - Technical Management, Accounting

DeVry University
Folsom, CA
07.2016

Associates - Science, Accounting

University of Phoenix
Sacramento, CA
11.2010

Skills

  • Microsoft Outlook
  • Microsoft Office: Word
  • Microsoft Office: Excel
  • Microsoft Office: PowerPoint
  • Google Suite
  • Zoom
  • Slack
  • Sales Force
  • Tableau
  • Windows 10
  • Windows 11
  • Computer skills
  • Printer
  • Facsimile
  • 10-Key by touch

Certification

  • Bookkeeping Certification, NACPB, In progress
  • Intuit Bookkeeping Certificate, Intuit Academy, In progress

Other Work Experience

  • Printed monthly patient account statements for payment.
  • Logged checks and created end of day report of monies received
  • Basic knowledge of HIPAA guidelines.

Timeline

Claims Coordinator – Remittance

OrthoFi
08.2021 - Current

Appeals Representative

Delta Dental of California
11.2018 - 09.2021

Claims Auditor

Delta Dental of California
09.2005 - 11.2018

Bachelors - Technical Management, Accounting

DeVry University

Associates - Science, Accounting

University of Phoenix

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Sheila Camara