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Shadina John

Shadina John

Network Operations Senior Analyst

Cigna-HealthSpring/ Non-Profit Development and Financial ManagementConsultant

My mission is to provide resources for a better life to those in need by assisting with housing placement, financial management and other necessities. I am also passionate about community development and I seek to work with non-profit organizations on their development and financial needs.

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Cigna-HealthSpring

Network Operations Senior Analyst

*Manage account of over 30 physicians in the Philadelphia region, for a top tier Medicare Advantage Plan, with a primary focus on increasing annual revenue and maintaining surplus of over $1million.
*Analyze financial and statistical data to identify areas of cost saving opportunities to be presented to Senior Leadership on a monthly basis.

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Cigna-HealthSpring

Provider Data Senior Associate

*Served as the subject matter expert for the QNXT Claims Module to conduct research on claims, provider denials, appeals and incorrect payments.
*Provided support for various existing incentives, including all Medicare STARs measures and Health Management Reports.
*Maintained demographic database of 100+ physicians within six (6) Physician Organized Delivery Systems (PODs).

Career

Quality Community Health Care, Inc.

Team Lead - Medical Billing Department

*Supervised a team of four (4) Billing Specialists in the Medical Billing Department of a Federally Qualified Health Center (FQHC) in the North Philadelphia region.
*Performed monthly analysis of accounts receivable reports to reconcile any outstanding patient and insurance balances and resolve unpaid medical claims.
*Conducted research regarding changes made to billing, reimbursement and physician credentialing guidelines.

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Quality Community Health Care, Inc.

Medical Billing Specialist

*Reviewed super bills for four (4) clinical sites to identify and submit billing for services rendered by healthcare providers.
*Input International Classification for Diagnosis (ICD-9) codes and Current Procedural Terminology (CPT) codes for over 180 patients daily.
*Reported insurance claim rejections to Billing Manager to ensure they are resolved accurately.

Career

Prodigy Learning Center

Pre-School Lead Teacher

• Planned developmentally appropriate lessons for sixteen pre-school children.
• Administered assessment to children based on lessons taught.
• Recorded observation and assessment records for sixteen pre-school children.
• Directed and implemented early childhood activities focusing on areas such as gross motor and social-emotional
development

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Temple University

Bachelor's Degree, Emelentary/Early Childhood Education