Shekesia Williams

Healthcare Claims Quality Analyst and Revenue Cycle professional with 7+ years of experience supporting Medicare, Medicaid, Commercial, and Durable Medical Equipment (DME) claims operations. Experienced in claims auditing, quality assurance, denial resolution, benefits coordination, eligibility verification, documentation review, and compliance monitoring. Proven ability to analyze claim accuracy, identify root causes of billing and documentation errors, evaluate workflow adherence, and improve quality outcomes through audit findings and trend analysis.

Skilled in Revenue Cycle Management (RCM), claims research, process improvement, quality reporting, and collaboration with leadership to reduce defects and improve reimbursement performance.

Coordination of Benefits Specialist (Remote) - Centene Corporation - Remote

(2023-09)

• Review and analyze healthcare claims to ensure compliance with Medicare, Medicaid, and commercial insurance guidelines.
• Investigate claim discrepancies and resolve eligibility, coordination of benefits, and reimbursement issues.
• Conduct detailed research of claim records, payer information, and supporting documentation to ensure claim accuracy and completeness.
• Identify root causes of claim processing errors, payment delays, and reimbursement issues.
• Support quality improvement initiatives through trend analysis and operational reporting.
• Maintain compliance with HIPAA, CMS regulations, and internal quality standards.
• Collaborate with cross-functional departments to improve claim accuracy and reduce rework.
• Consistently maintain productivity and quality standards within a high-volume remote environment.

Claims Resolution Specialist – DME Focus - Integra Partners

(2021-04 - 2023-09)

• Processed and resolved complex Durable Medical Equipment (DME) claims for Medicare, Medicaid, and commercial health plans.
• Performed detailed claim reviews to verify billing accuracy, documentation completeness, and compliance with payer requirements.
• Investigated denied claims, underpayments, and reimbursement discrepancies through root cause analysis.
• Evaluated claim transactions and supporting documentation to identify quality concerns and process improvement opportunities.
• Applied state-specific and payer-specific billing requirements to ensure accurate claim adjudication and reimbursement.
• Collaborated with operations teams to reduce claim defects, improve first-pass resolution rates, and minimize rework.
• Assisted with training and mentoring staff on claims processing procedures, documentation standards, and quality expectations.
• Maintained exceptional quality and productivity performance while meeting departmental goals.

Health Information Specialist (Remote) - Datavant - Remote

(2025-12 - 2026-03)

• Processed requests for protected health information while maintaining HIPAA compliance.
• Reviewed medical records for accuracy, completeness, and release authorization requirements.
• Prepared and organized patient records for retrieval and disclosure.
• Maintained detailed documentation and ensured timely completion of requests.

Document Control Clerk - Palmetto GBA

(2018-01 - 2021-04)

• Reviewed, indexed, and maintained healthcare documentation supporting claims processing and reimbursement activities.
• Verified document accuracy and compliance with Medicare guidelines.
• Maintained high productivity and quality standards while processing large document volumes.

Claims Processor - BlueCross BlueShield of South Carolina

(2016-08 - 2018-01)

• Processed healthcare claims according to established policies and procedures.
• Reviewed claims for completeness, accuracy, and eligibility requirements.
• Researched claim discrepancies and assisted with resolution activities.
• Maintained compliance with payer regulations and quality standards.

Associate of Science - Medical Assisting