Workers Compensation Claims

Full Legal Name:- Danielle Nichols-Stephens

Best and Alternate contact numbers:- 251-***-****

E-Mail Address:- ********.*********@*******.***

Candidate Current Location (City, State & Zip Code):- Atmore, AL 36502

Willing to relocate: Anywhere.

Summary:

Workers Compensation Claims Consultants of MI, MN, SC, NC, WI, and Texas.

Entered workers comp claims into Epic.

Kept up to date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same.

Understood medical terminology and standard medical procedures as they pertain to worker's compensation, U.S. Longshoreman's and Jones Act claims.

Evaluated claim exposure, negotiated, and resolved claims.

Transcribed audio for 6 adjusters.

Experience in handling bodily injury claims.

Work Experience

NTT Data – Remote Contract April 2023 to Present

Claims Analyst

Pay claims that have a denial code in CenPas using Amisys.

Enter codes and follow the workflow chart to properly bring claims to a pay status of 92.

Caseload of 100 claims per day.

Work claims using the state workflow

Work COBs using CCAT Workflow

Enter information in Amysis from 1450 and 1500 claims.

Verify if the claim is paper or electronic

Update EX pend codes using EX overrides/search provides/search members denial codes.

MEMIC - Remote claims May 2022 to Mar 2023

Claims Adjuster Specialist l (Temporary)

Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure.

Maintains contact throughout the life of the file as needed.

Administers the delivery of timely, appropriate, and accurate indemnity and medical benefits.

Evaluates claim exposure, negotiate, and resolve claims.

Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary.

Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.

Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling.

Maintains quality claim files.

Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate.

Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate.

Keeps up to date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same.

Understands medical terminology and standard medical procedures as they pertain to worker's compensation, U.S. Longshoreman's and Jones Act claims.

OfficeTeam - Robert Half Staffing Agency - Remote February 2021 to May 2022

Workers Compensation Claims Consultants State of MI, MN, SC, NC, WI, and Texas

Enter New LT/MO claims into Claim Center and Risk masters.

Review medical, legal, and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims.

Transcribe audio for 6 adjusters.

Review claims for processing.

Collect all data needed to create/enter the claim.

Use Maven to lookup insured information.

Email clients, and claimants through ECF.

Transcribe all voicemail recordings for 6 supervisors/employees.

Enter up to 80 medical notes per day from medical records.

Collect required documentation, review file documentation, and make sure all items needed are requested.

Ensure that all claim documentation is complete, accurate, and complies with company policy.

Establish, maintain, and update files, databases, records, and other documents for recurring internal reports.

Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials.

Contact and communicate with clients by telephone, e-mail, or in-person.

Make follow-up calls and place notes in Risk masters 3rd attempt send for denial.

Upload and enter data into Risk Master set diary for second and third attempt to reach claimant, upload documents into OnBase.

Update spreadsheets, file data away.

Complete Claim input sheet, enter Case management LDW and RTW then close accounts.

Core Diagnostic Laboratories – Birmingham, AL December 2019 to February 2021

Lab Assistant/Data Entry

Entered requisitions into LabDaq, entered billing for UB's and HICF forms.

Created new patient accounts, enter.

Entered, and verified insurance, scan, uploaded files, created spreadsheets and entered month- end reports onto a shared spreadsheet, received and sorted clinical lab specimens, prepared specimens for testing and analysis, scanned and/or ordered entry of patient and specimen information.

Lexicon, Inc - Birmingham, AL April 2019 to December 2019

Document Control Clerk

Audit and update EAF, SMS, and VTD drawings.

Print blueprints daily.

Type all correspondence for project managers.

Keep all employees updated on new policies or changes.

Assist with light payroll.

File and retrieve documents using specific classification and organization systems.

Responsible for the orderly recording and keeping of physical and electronic documents, including distributing new documents and discarding obsolete records.

Scan documents into Procore, create files, help with orientation, and experience with safety Documents.

Cobbs Allen - Birmingham, AL March 2018 to April 2019

Workers Compensation Claims Adjuster AL and FL

Handled month-end report.

Transcribed audio.

Collect data to set up a new claim in Epic/AS400

Called claimants for initial statements.

Entered workers comp claims into Epic.

Entered reserves into Epic and AS400, paid bills.

Experience in handling bodily injury claims.

Transcribe all incoming voicemail/notes from physicians.

Entered workers comp billing.

Paid bills, printed checks.

Mailed out checks.

Sorted, stamped, and opened mail.

Answered phones. approvals/orders from doctors to health facility Produce digital copies of documents for retention purposes.

Excellent Customer Service.

St. Vincent's Medical - Birmingham, AL May 2014 to March 2018

Record Imaging Clerk

ST Vincent's East/R1 Rcm

Compiled sorted and verified accuracy of data to be entered in Sovera and One

Chart. Billing, scanned all insurance correspondence, fax, copied, answered phones, calculated checks from patients.

Entered check information onto a spreadsheet, interacted with Finance department with checks.

Performed verification and indexing of imaging for quality batch identification, sorted mail.

Excellent Customer Service.

Records Management ensured vital historical, fiscal, and legal value are identified and preserved, and that non-essential records are discarded in a timely manner according to established guidelines and identified legislation.

Next Total Fitness - Birmingham, AL April 2012 to April 2014

Receptionist

Next Total Fitness.

Made deposits.

Welcomed visitors by greeting them, in person or on the telephone; answered or referred inquiries. Directed visitors by maintaining employee and department directories, giving instructions.

Entered data for existing and new members.

Data entry entered all members information into Pro Sales.

Ran cash drawer, open and closed gym, faxed, copied, and sorted mail.

Marathon Electrical Contractors June 2008 to September 2012

Accounts Payable Clerk

Identified and resolved any discrepancies to an account.

Retrieved, sorted, and distributed mail to Project Managers and other staff.

Paid employees by receiving and verifying expense reports and requests for advances.

Disbursed petty cash by recording entry; verifying documentation Printed checks for reimbursement of mileage and miscellaneous.

Paid vendors and company bills

Prepares and processes payments accurately and on time for amounts owed by the company.

Reviewed and verified all purchase orders, statements, and invoices needed to prepare payments.

Bellsouth Osha Records - Birmingham, AL October 2007 to June 2008

Claims Assistant (Personal and Motor Vehicle Injuries)

Entered workers compensation claims into the system for Motor vehicle and personal injuries claims.

Answered calls concerning injuries while on the job.

Communicated with OSHA Headquarters about posting OSHA Logs.

ST. Vincent's Birmingham - Birmingham, AL May 2004 to October 2007

Medical Records Clerk

Gathered patient information by collecting demographic information from a variety of sources.

Trained and learned how to transcribe Physician notes.

Interacted with registration areas and physicians' offices, retrieved information from automated printer.

Initiated the medical record by creating and processing the patient care record folder.

Maintained record availability by processing charts into the department, using chart mark-off procedures, facilitating chart location activities.

Retrieves medical records by following chart-out procedures; documenting reasons charts cannot be retrieved for statistical and follow-up purposes.

Delivers charts to assigned areas of the hospital by following established routing procedures.

Kept health care providers informed by communicating availability or unavailability of the record.

Maintained quality results by following hospital standards.

Education:

Bachelor of Science in Accounting (no degree) from Strayer University - Birmingham, AL

July 2016 to April 2019

High school diploma from Jefferson State Community College - Birmingham, AL

May 1999 to December 2000

Skills:

Epic

Microsoft Outlook

Workers' Compensation

Procore

CPT Coding

Typing 50 wpm (10+ years)

Microsoft Word

Microsoft Office

Microsoft PowerPoint

AS400

Excel

Project Management

Medical Billing

Insurance Verification

Customer service

Clerical experience

QuickBooks

Medical Records

Employee Orientation

Hospital Experience

Data Entry

HIPAA

Payroll

Medical Coding

EMR Systems

Medical terminology

Microsoft Excel

Anatomy Knowledge

ICD Coding

Time management

Administrative experience

Laboratory Experience

Medical Office Experience

Negotiation

Documentation review

VPN

Case management

Analysis skills

Medical documentation

Windows

Accounting software

Construction

Records management

Google Suite

Property management

Accounting

Accounts payable

SharePoint

ERP systems

Auditing

Writing skills

Computer skills

Maven

Data collection (10+ years)

Research

Communication skills

EHR systems

HCPCS

ISO 13485

Data collection

EDI

Document Management

Image Right (1 year)

CXP (1 year)

Claims Xpress (1 year)

CareMC (1 year)

Cisco jabber (3 years)

Webex (3 years)

Quality Assurance

Certifications & Licenses:

AED Certification

First Aid Certification

CPR Certification

Contact this candidate