Deasha Mcbride
Atlanta
Summary
Physician Denials & Appeals Specialist with over 9 years of experience supporting physician and ambulatory practices through complex professional claim denial resolution and revenue recovery. Proven expertise across Physician Denials Specialist, Denials & Appeals Specialist, and Revenue Cycle AR roles, with a strong focus on high-dollar claims, aged A/R, and appeal overturns. Highly skilled in medical necessity, authorization, eligibility, timely filing, and coding-related denials for CMS-1500 professional billing. Certified in CSPPM, CRCR, and CSAPM, with advanced knowledge of CMS regulations, LCD/NCD guidelines, and commercial payer policies. Known for improving reimbursement outcomes, reducing denial rates, and partnering with providers and payers to recover lost revenue while maintaining strict compliance standards.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Revenue Cycle /Senior Medical Billing Specialist
OBC
06.2022 - Current
- Manage end-to-end physician and ambulatory billing across multiple payers
- Submit and monitor high-volume claims ensuring first-pass accuracy
- Perform insurance follow-ups to resolve unpaid, underpaid, and denied claims
- Analyze and correct denials related to coding, medical necessity, eligibility, and authorization
- Reduce A/R by aggressively working aging accounts (30–120+ days)
- Post payments, adjustments, and refunds while reconciling EOBs
- Ensure strict compliance with CMS, payer contracts, and HIPAA regulations
AR / Denials Specialist
Ternium
01.2021 - 04.2022
- Resolved complex denials through appeals, reconsiderations, and payer outreach
- Managed high-volume A/R follow-up for physician and ambulatory services across Medicare, Medicaid, and commercial payers
- Verified benefits and eligibility prior to billing to prevent denials
- Collaborated with providers and internal teams to correct documentation issues
- Managed high-volume A/R follow-up for physician and ambulatory services across Medicare, Medicaid, and commercial payers
Denials & Appeals Specialist
Care Source
10.2019 - 12.2020
- Analyze and resolve complex medical claim denials across Medicare, Medicaid, and commercial payers
- Prepare, submit, and track formal appeals and reconsiderations with supporting medical documentation
- Investigate denials related to medical necessity, authorization, eligibility, coding, and timely filing
- Conduct in-depth EOB and remittance analysis to identify underpayments and reimbursement discrepancies
Physician Denials Specialist
Piedmont Hospital Atlanta
07.2016 - 09.2019
- Resolve complex physician claim denials for professional services billed on CMS-1500 claims
- Interpret CMS guidelines, LCDs/NCDs, and payer policies to support appeal determinations
- Review provider documentation to ensure compliance with medical necessity requirements
- Work aged professional A/R (60–120+ days) with focus on high-dollar claims
Patient Access Representative
Northside Hospital Atlanta
01.2014 - 05.2016
- Ensure that patient billing and collections are handled professionally and compassionately.
- Facilitated smooth billing processes by verifying insurance eligibility, obtaining authorizations, and accurately entering claim details into the system.
- Maintained accurate patient records, contributing to a well-organized database for seamless information access across departments.
Education
High School Diploma -
Statesboro High School
Statesboro, GA05.2011
Skills
- Professional Billing (CMS-1500)
- Appeals & Reconsiderations
- Medical Necessity Denials (LCD/NCD)
- Accounts Receivable Follow-Up (60–120 Days)
- High-Dollar Claim Prioritization
- CPT / ICD-10 / HCPCS Review
- Modifier Review (25, 59, XE, XU)
- Medicare & Medicaid Appeals
- Commercial Payer Appeals (BCBS, Aetna, Cigna, UHC)
- EMRs: Epic, Cerner, Athena, eClinicalWorks, NextGen, Medent
- Clearinghouses: Availity, Change Healthcare
- Payers: Medicare, Medicaid, BCBS, Aetna, Cigna, UnitedHealthcare
Certification
- April 2025 CRCR – Certified Revenue Cycle Representative
- May 2025 CSAPM – Certified Specialist Ambulatory Practice Management
- June 2025 CSPPM – Certified Specialist Physician Practice Management
Timeline
Revenue Cycle /Senior Medical Billing Specialist
OBC
06.2022 - Current
AR / Denials Specialist
Ternium
01.2021 - 04.2022
Denials & Appeals Specialist
Care Source
10.2019 - 12.2020
Physician Denials Specialist
Piedmont Hospital Atlanta
07.2016 - 09.2019
Patient Access Representative
Northside Hospital Atlanta
01.2014 - 05.2016
High School Diploma -
Statesboro High School