Human Resources M E
Resume:
Danielle L. Byrd
**** ****** **** • Converse, TX 78109
***************@*****.***
Summary of Qualifications
D i s p u t e A n a l y s i s C u s t o m e r S e r v i c e R e c r u i t m e n t O p e r a t i o n s
Resourceful Provider Dispute Analyst with a keen ability to meticulously analyze, research, and efficiently resolve payment claims within designated timelines. Committed to providing exceptional service and ensuring customer satisfaction. Seeking to leverage skills and experience to contribute to the success of a reputable organization.
C o r e C o m p e t e n c i e s :
Claims Processing Resource Management Services & Procedures End-To-End Recruitment Operations Candidate Sourcing & Selection Training & Development Team Building & Management
Education Experience
Wayland Baptist University, San Antonio, TX
Masters Degree in Business Administration and Human Resources
02/2018-6/2019
Wayland Baptist University, San Antonio, TX
Bachelors Degree in Business Administration and Medical Management
08/2016-08/2017
Kaplan College, San Antonio, TX
Associate Degree in Business Administration and Medical Practice Management
10/2009-02/2011
Judson High School, Converse, TX
Diploma, 1991
Computer Skills
Advanced computer skills in Access, PowerPoint, Word
Learns new software applications quickly
Keyboard/Type 50wpm
Employment Experience
3M/KCI 08/2021-Present
CSR/Insurance Verification
Assists Clients and Customers, via telephone, e-mail or chat, with orders, inquiries, requests, problem resolution, and comments/feedback regarding products/services and verification. Consults with Clients and Customers to identify additional needs related to the products or services. Insure Correct billing ICD10 are applied. Recommends appropriate products, services, or solutions. Works on assigned client programs. Performs duties in a courteous, efficient, and professional manner. Work directly with Government and Commercial Insurance verification of coverage and benefits to include processing of all medical devices and supply orders.
Bright Healthcare
Provider Dispute Analyst 07/2021-8/2023
Efficiently reviewed and researched dispute cases, resulting in accurate claims reprocessing, and adeptly created and maintained appeal response templates.
Functioned as a valuable departmental resource for appeal-related concerns and consistently maintained a robust grasp of fundamental medical terminology to enhance comprehension of services and procedures.
Leveraged effective problem-solving skills to drive dispute resolutions, fostering mutual understanding of opposing viewpoints.
Thoroughly validated and ensured the accuracy of documentation on updated systems.
Consistently adhered to departmental processes, procedures, and goal expectations for conducting case investigations.
Investigated, researched, and promptly resolved payment claims within stipulated timeframes.
Maintained current industry knowledge, and tracked system updates, network regulations, and compliance matters.
Demonstrated sound judgment and utilized available resources to make informed decisions for case approval or denial.
Patient Solutions 01/2021-7/2021
Office Manager/Medical Billing
Assists Clients and Customers, via telephone, email or chat, with orders for DME, inquiries, requests, problem resolution, and comments/feedback regarding DME equipment (CPAP/APAP devices, wheelchairs, and supplies). Medical Billing Department AR reporting, posting and balance patient account, billing medical insurance and private pay. Conduct daily office task of order supplies, inventory, and maintain office employment.
Medtronic San Antonio Tx. 07/201*-**-****
Supply Manager/Insurance Verification
Assists Supply Clients and Customers, via telephone, e-mail or chat, with orders, inquiries, requests, problem resolution, and comments/feedback regarding products/services and verification. Consults with Clients and Customers to identify additional needs related to the products or services. Recommends appropriate products, services, or solutions. Works on assigned client programs. Performs duties in a courteous, efficient, and professional manner. Work directly with Government and Commercial Insurance verification of coverage and benefits to include processing of all medical devices and supply orders.
United Healthcare, San Antonio, Tx 03/2013-6/2014
Enrollment Processor, Provider Data Analyst, Grievance &Appeals Coordinator
Handled special projects from outbound calls to internal paperwork needing to be entered into the system.
Received tasks from other departments to handle, was given Helpdesk role for CIP after 4 months of employment.
Managed about 10-15 people and provided training and individual coaching sessions for all associates.
Maintained detailed and accurate records between multiple databases and programs.
Checked documentation for accuracy and validity on updated systems.
Maintained confidentiality of patient eligibility, records, and heath statuses.
Verified client information by analyzing existing evidence on file
Handled escalated issues for member by making outbound calls to provider and other entities.
Assisted members with claims questions regarding diagnosis codes, copayment, appeals, fraud claims and reimbursement requests.
Created and maintained multiple databases, including, contract provider network, prior authorization, third party liability, provider set ups and related corrections.
Scheduled monthly provider verifications regarding provider enrollment specifications and demographic changes.
Updated delegated provider Medicare and Medicaid documents on a monthly and ad hoc basis and ensure state compliance.
Reviewed appeals, complaints and claims from providers, determined validity and help build satisfactory resolutions.
Managed time efficiently in order to complete all tasks with deadlines
Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
Conducted full claim and appeal investigations and reported updates and resolutions.
Maintained knowledge of benefits claim processing, claims principles, medical terminology, appeal procedures, and HIPAA regulations.
South Texas for Pediatric Care 10/2010-02/2013
Billing Specialist
Obtain new sales information from managers and prepare invoices to be sent to patient/customers. Interact with patients via phone and email regarding unpaid balances and discuss options for payment. Set up payment plans for customers upon request and provide updated information to accounting manager. Cross-check information entered into bookkeeping software to ensure accuracy and report any discrepancies to manager. Trained incoming staff members on office billing practices and procedures.
Additional References are Available Upon Request
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