Claims Specialist
Resume:
Danielle Nichols-Stephens
Atmore, AL *****
********.*********@*******.***
· 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
Operation Associate II
R1 RCM - Remote
January 2024 to Present
• Call, email, or fax carriers for bill status.
• View bills in Epic
• Send itemized bills via mail with medical notes for processing.
• Update carrier/bill status notes in CDP.
• View bills, patient information, payment, and medical documentation in Epic.
• Add workflow information in resolution.
• Work bills in Que and move to the next workflow.
• Provide info of claimants to carriers for bill status. Claims Analyst
NTT Data – Remote Contract - Remote
April 2023 to January 2024
• Paid 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
• Looked up member info in Apollo.
Claims Specialist LT (Temporary)
MEMIC - Remote
May 2022 to March 2023
· 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. Claims Consultant
OfficeTeam - Robert Half Staffing Agency - Remote
February 2021 to May 2022
Workers Compensation Claims Consultants State of MI and MN
• 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. Lab Assistant/Data Entry
Core Diagnostic Laboratories - Birmingham, AL
December 2019 to February 2021
· 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. Document Control Clerk
Lexicon, Inc - Birmingham, AL
April 2019 to December 2019
· 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. Workers Compensation Claims Adjuster AL and FL
Cobbs Allen - Birmingham, AL
March 2018 to April 2019
· 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.
Record Imaging Clerk
St. Vincent's Medical - Birmingham, AL
May 2014 to March 2018
· 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.
Receptionist
Next Total Fitness - Birmingham, AL
April 2012 to April 2014
· 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. Accounts Payable Clerk
Marathon Electrical Contractors - Birmingham, AL
June 2008 to September 2012
· 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. Education
Coursework/Bachelor of Science in Accounting
Strayer University - Birmingham, AL
July 2017 to April 2019
High school diploma
Jefferson State Community College - Birmingham, AL May 1999 to December 2000
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