Shannon J.
Mid-Level Medical Billing Specialist
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Shannon J. is a dedicated Medical Billing and Claims Specialist with extensive expertise in the healthcare sector, primarily focusing on CPT, ICD-10, and HCPCS coding. Based in Cainta, Philippines, Shannon specializes in analyzing and resolving medical claims. He has established a reputation for accuracy in charge review and insurance verification, alongside adeptness in managing denials and executing effective appeals to optimize reimbursement processes. Shannon worked as a Senior Medical Billing Specialist at Connext, managing complex inpatient and outpatient claims, adhering to payer policies and CMS regulations, and fostering process improvements. His role as a Technical Denials—Appeal Writer at Conifer involved staying updated with payer policies and crafting well-supported appeals. Previously, he enhanced verification accuracy as a Quality Analyst at Med-metrix, achieving notable success in error reduction. His proficiency extends to EOB/ERA interpretation and HIPAA-compliant documentation. Shannon’s educational background includes coursework in Planning & Project Management and an ongoing pursuit of a Civil Engineering degree.
Experience
Sen. Medical Billing Specialist
Connext · 2025 — 2026Conducted senior-level medical billing by reviewing and coding complex outpatient and inpatient claims using CPT, ICD-10, and HCPCS. Executed charge edits and scrubs to ensure accuracy for clean claim submission. Managed follow-ups with payers and negotiated claim adjudications to address rejections and underpayments. Prepared and submitted timely appeals with required documentation while coordinating with clinical teams to rectify coding discrepancies. Ensured compliance with payer policies and CMS regulations and provided suggestions for process improvements to enhance reimbursement speed.Technical Denials - Appeal Writer
Conifer · 2025 — 2025Remained up-to-date with payer policies, CMS regulations, and evolving medical billing and coding requirements (CPT, ICD-10, HCPCS). Reviewed and analyzed medical claims that were denied to uncover the root causes of technical denials and determine corrective actions. Evaluated payer remittance advice (EOBs/ERAs) to confirm denial reasons and ensure timely filing of appeals. Collaborated with billing, coding, and utilization review teams to gather essential documentation and clarify clinical or procedural details needed for appeals.Quality Analyst
Med-metrix · 2022 — 2025Examined insurance verification processes for compliance and accuracy, verified client information, and analyzed data trends to optimize operations. Conducted thorough audits of insurance verification processes to maintain adherence to established protocols, significantly reducing errors. Worked alongside Team Leaders, Operation Managers, and Clients to ensure alignment with processes for continued progress and growth.Sen. Customer Collections Representative
NTT Data · 2022 — 2022Possessed experience in medical accounts receivable follow-up, which included tracking insurance claims, analyzing and resolving denials, interpreting EOBs/ERAs, and managing appeals. Demonstrated strong knowledge of CPT, ICD-10, and HCPCS coding, payer guidelines, and revenue cycle processes. Proficient in EMR/EHR systems, payer portals, and Excel, with the ability to navigate high-volume accounts while maintaining effective analytical, communication, and time management skills.Customer service representative
Concentrix · 2019 — 2019Addressed customer inquiries concerning orders, refunds, returns, and product information with a focus on achieving first-contact resolution. Utilized Amazon’s internal systems to manage order tracking, process refunds, and escalate complex issues for timely resolutions. Delivered outstanding support to customers through phone, email, and chat.
Skills & Expertise
Education
- 3rd Year College Undergraduate - Bachelor of Science in Civil EngineeringTechnological Institute of the Philippines · — — 2022
- Senior High School GraduateTechnological Institute of the Philippines · — — 2019