Danielle Krol

330-***-**** ad2xqa@r.postjobfree.com 1451 Smith Kramer St. Hartville, OH 44632

** ***** ** ********** ** Internal Auditing, Claims Processing, DME, Authorization and Medical Billing Professional Experience

Chesterfield Resources – Uniontown, OH (July 2017 – Present) Internal Audit

• In charge of auditing high claims ($5,000 and above); all random claims performed by claims processors daily.

• Handles all reports for Salvation Army officers and employees involving medical claims.

• Handles all aged claims to be rebased through auditing.

• Ensures turnaround time on receiving claims are processed and audited is 10 days.

• Expectation of my position is to audit 75 claims; I have achieved 105-150 daily. SummaCare, Inc. – Akron, OH (May 2012 – July 2017) Internal Audit (SummaCare)

• Auditing claims, eligibility, customer service, accounts receivable and CMS processes within the Client Service division to verify consistency with policies.

• Ensures processes conform to regulatory requirements, accrediting standards, contractual agreements and internal policies.

• Develops and maintains reports needed to measure performance and thrives in quality improvement within Client services.

• Assists in audits of operational data, financial data, and processes to verify consistency with policies and procedures.

• Reports audit findings to Manager, Auditing and assists with preparation of internal and external reports submitted to Senior Mgmt.

• Makes recommendations for and reviews corrective action plans for review and approval by Manager. Auditing and/or Compliance officer as needed.

• Secret shopper audit calls to Medicaid customer service reps, maintaining spreadsheet of all reps and the outcome of each call sent to Customer Service mgmt. team.

• Desk Audits - to ensure all employees are following guidelines on any PHI- Protected Health Information; this ensures all operations, activities and business affairs of SMSO and its employees are confidential.

Danielle Krol

330-***-**** ad2xqa@r.postjobfree.com 1451 Smith Kramer St. Hartville, OH 44632 Senior Claims Processor (SummaCare)

• Analyzes and resolves files and requiring complex adjustments in accordance with established guidelines.

• Processing all types of Claims, promptly and accurately to ensure self-funded service standards, prompt pay standards and regulatory requirements are met. Makes appropriate determinations on pended claims and applies unbundling logic as determined by current coding software.

• Analyzes and resolves various reports/projects associated with claims processing, including, but not limited to, EOP error, extract reports, case agreements, self-funded client reports, repricing.

• Identifies issues proactively, and quantifies magnitude of issue by utilizing Microsoft Office tools such as Access/Crystal reports, Excel and Word. Creates and communicates in writing, action plans for resolution.

• Assists newly trained processors with questions or concerns, and works with Claims Specialists and Team Leads to communicate and coordinate additional training needs. Claims Processor (SummaCare)

• Processes all types of Claims promptly and accurately.

• Responsible for creating and maintaining four reports for the dept. -Jcodes, Vaccines, Excess Deductibles and F5 pends.

• Completes assignments in the most efficiently.

• Assists new hires with claims questions and concerns. Vertexer (SummaCare)

• Temporary, to-hire employee (SummaCare).

• Scans documents to meet level production and quality standards.

• Identifies and reports errors.

• Reports production stats, and time according to documentation. 51 Oakwood – North Canton, OH (2011 – 2012)

• Claims Processing Specialist

• Solving any and all conflicts to have claims paid, audits and collections. Danielle Krol

330-***-**** ad2xqa@r.postjobfree.com 1451 Smith Kramer St. Hartville, OH 44632 Cornerstone (SummaCare) – Akron, OH (2010 – 2011)

• Customer service, filing, and record keeping.

• Built lasting relationships with customers by meeting and exceeding expectations. Medical Resources – Akron, OH (2009 – 2010)

• Customer service, servicing over 4,000 clients

• Maintained 100 % customer satisfaction

• Performed billing, invoicing, filing and collections. Akron General Medical Center / NOOA Group – Akron, OH (2008 – 2009)

• Medical billing for Orthopedic group

• Coder/CPT and ICD-9 Registration specialist.

Marlington Local School District – Alliance, OH (2000 – 2007)

• Telecom munity Technician for School District

• Video Conferencing and Distance Learning Management

• Educational Aide through the Dept. of Education/maintained over 3,000 student/staff media records.

• Speech and Debate Coach, Video News Coach, Destination Imagination Coach, Summer Superintendent assistant for Administration office.

• PTO Vice President

Sally Beauty Supply – Canton, OH (1996 – 2000)

• Store Manager

• Human Resources

• Scheduling, developing store fronts

• Marketing/Clairol professional development classes. Danielle Krol

330-***-**** ad2xqa@r.postjobfree.com 1451 Smith Kramer St. Hartville, OH 44632 Awards & Volunteer Experience

Marlinton Local School District Moon Moulin Award (for excellence in mentoring students) Most Influential Person award nominated by students, four years presented at Mount Union College. Since 2003 rescues dogs/cats from various outreaches, including Summit County Animal Control, Stark County Humane Society, Stark County Dog warden and PetValu of Hartville. Education & Skills

• Graduate of Marlington High School

• Proficient with Microsoft Office (Word, Excel, Outlook)

• Proficient Amisys / Macess / Click for Care / Lawson

• Excellent Communication and Telecommunication

• Faxing, Scanning, Copying

Special Roles & Memberships

• Summa Health Ambassador • Employee Engagement Committee Member

• Fraud, Waste, Abuse Committee Member • Company Fun Committee Officer References

Kimberly Dye 330-***-**** Summa Human Resource Department Lori Collins 330-***-**** Chesterfield Senior Auditor Samantha Bennett 330-***-**** Chesterfield Wellness Nurse

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