Sherajane Antipasado

Highly competent in handling the entire billing cycle. Knowledgeable in the AR follow-up, billing, and insurance coverage, thereby meeting the highest possible reimbursement and minimum possible claim denials. Dedicated to maximizing operational efficiency and financial accuracy at each step of the medical billing process.

Work Samples & Case Studies Denials Management Case Study – Behavioral Health, Pain Management

Workplace: Peoples Healthcare LLC Integrity

• Denial Reason: Claim denied due to lack of medical necessity documentation.
• Resolution Approach: Collaborated with the provider to obtain detailed clinical notes supporting medical necessity. Submitted a well-documented appeal with ICD-10 and CPT justification.
• Outcome: Successfully overturned denial, resulting in full reimbursement of $1,200.

Workplace: Peoples Healthcare LLC Integrity

• Issue: 60+ day aged claims pending payment from United Healthcare.
• Resolution Approach: Identified common trends causing delays, initiated payer calls, and resubmitted corrected claims.
• Outcome: Recovered over $15,000 in outstanding claims, reducing AR days by 20%.

Workplace: Healthcare Coding Integrity

• Issue: Claims denied due to missing modifiers on outpatient mental health services.
• Resolution Approach: Conducted a comprehensive review of CPT coding and payer requirements, appended correct modifiers, and resubmitted claims.
• Outcome: 90% of resubmitted claims were approved, generating over $5,000 in revenue.

• Tebra (Kareo)
• Dr Chrono
• PointClickCare
• Simple Practice
• AdvancedMD
• NetHealth
• Google sheets and acrobat
• Ring Central
• Noridian
• Claims rejection management
• IVR forms
• Availity
• Pverify
• Slack and Teams