SHARON GASTON
Hampton
Summary
Over ten (10) years of experience working in patient accounts to ensure billing, claims filing, data entry, and collection of amounts due are achieved for assigned providers. Additionally, professional career includes over 20 years of leadership experience in administration to effectively create and maintain a high-performance work environment and strong team.
Dedicated Account Resolution Specialist adept at working in fast-paced environments. Knowledgeable about research strategies, claims handling, and payment plans. Desiring to bring many years' experience in the field to a dynamic new position.
Overview
19
19
years of professional experience
1985
1985
years of post-secondary education
Work History
Account Resolution Specialist
Children’s Healthcare of Atlanta
Atlanta
07.2025 - Current
- Oversee and manage patient accounts associated with Blue Cross Blue Shield (BCBS) payors, ensuring that all financial records are accurate and current.
- Diligently work each patient account to full resolution, whether that means securing payment or addressing outstanding issues.
- Regularly update account information to reflect the most recent actions taken and promptly identify any unpaid or problematic accounts.
- Direct these unresolved accounts to the appropriate department so they can receive specialized assistance and be resolved more efficiently.
- Proactively reach out by calling BCBS representatives directly whenever claim issues arise, facilitating prompt solutions and minimizing delays in reimbursement.
- This comprehensive approach ensures streamlined revenue cycle management, maximized collections, and improved financial health for the hospital.
Billing Specialist/AR Manager
Regenerative Orthopaedics and Spine Institute
Stockbridge
03.2024 - 07.2025
- Manages the accounts receivable to ensure appropriate billing to payers.
- Submits electronic and paper claims with supporting documentation to third party payers.
- Follows policies and procedures related to collection and make recommendations for improvements.
- Revises claim denials and employs effective appeal methods promptly.
- Strong knowledge of addressing and preventing common denial reasons.
- Utilizes payer websites and resources for maximum work effectiveness.
- Communicates coding, compliance, managed care, and rehab issues related to other departments.
- Proficient in Code X program, including CCI edits, bundling logic, coding combinations, modifiers, and diagnosis codes.
- Accurately interprets payer explanations of benefits to ensure services meet established standards.
- Communicates clearly in all written and oral formats, including email.
- Familiar with EMR systems Epic and Athena; proficient in Excel, Word, Outlook, and SharePoint.
- Maintains positive relationships with individuals, families, providers, and referral sources.
- Performs financial analysis promoting best practices; identifies improvements affecting program performance.
- Serves as a Subject Matter Expert for programs throughout the customer engagement process.
- Leads teams to support departmental strategies and initiatives.
- Generates reports for management & provides technical assistance on billing issues.
Patient Accounts Representative
Resurgens Orthopaedics
Fayetteville
10.2007 - 03.2024
- Manages the accounts receivable to ensure appropriate billing to payers.
- Submits electronic and paper claims with supporting documentation to third party payers.
- Follows policies and procedures related to collection and make recommendations for improvements.
- Promptly revises claim denials and utilizes effective appeal methods.
- Strong working knowledge of how to effectively address and prevent common denial reasons.
- Familiarity and ability to effectively utilize payer websites and other available resources for maximum work effectiveness.
- Communicates any issues relating to Coding & Compliance, Managed Care, and Rehab concerning duties of other departments.
- Strong working knowledge of Code X program, including CCI edits, bundling logic, coding combinations, modifiers, and diagnosis codes.
- Ability to accurately interpret payer explanations of benefits to ensure authorized services were provided in accordance to established standards.
- Ability to communicate clearly and concisely in all written and oral communications, including email.
- Strong working knowledge EMR system Epic and Athena, working knowledge of Excel, Word, Outlook, and SharePoint.
- Maintains positive relationships with individuals, family, providers and all referral sources.
- Performs financial analysis, promotes financial management best practices, and identify and suggest improvements in a variety of financial areas affecting program performance.
- Serves as a Subject Matter Expert for programs and services throughout the customer engagement process.
- Lead teams in support of key strategies, goals and initiatives for the department.
- Generate reports for management and provides technical assistance regarding billing issues.
Education
Associate - Applied Science
Fiorello H. LaGuardia Community College
Long Island City, NYSkills
- Claims processing
- Billing compliance
- Coding accuracy
- Electronic claims submission
- Revenue cycle management
- Denial resolution strategies
- Team leadership
- Effective communication
- Problem solving
- Attention to detail
- Time management
- Relationship building
- Inbound call management
- Debt collection
- Goal-oriented mindset
- Information gathering
- Research
- Documentation skills
- Claim handling
- Financial collections
Timeline
Account Resolution Specialist
Children’s Healthcare of Atlanta
07.2025 - Current
Billing Specialist/AR Manager
Regenerative Orthopaedics and Spine Institute
03.2024 - 07.2025
Patient Accounts Representative
Resurgens Orthopaedics
10.2007 - 03.2024
Associate - Applied Science
Fiorello H. LaGuardia Community College