Claims Specialist Patient Care
Resume:
WYNDI MCDONALD
+1-614-***-**** ************@*****.*** 45 Flamingo Dr, Newark, OH
EXPERIENCE
Special Utilities Representative
DigiTech
In the first month of employment, identified numerous backlog claims and brought to current status in less than 2 weeks Worked claims that were rejected by the clearinghouse, ensuring timely resolution and compliance with insurance rules and regulations
Collected explanations of benefits for paid claims to ensure accurate payment records3
Completed credentialing with insurance companies to secure timely payments
Reviewed and addressed claims on hold, identifying and resolving issues to facilitate claim processing
Clean Claims Specialist
Advocate RCM
08/2021 - 08/2024 Remote
Consistently ranked in top 80% of team production metrics. Corrected a 2yr long issue in the first 6 months of employment. Over 5,000 claims resulting in $1M+ in savings for the provider. Ensured internal ECS system is setup correctly to bill claims from beginning to payer processing.
Worked ECS rejections from our Clearinghouse and Payers. Researched new rejections and monitor for trends.
Monitored insurance plan setup and review payer IDs. Managed workflow and processes for our document
management system.
Patient Care Representative
Quantum Health
08/2019 - 06/2021 Worthington, OH
Check to ensure the appropriate changes are made to resolve customers' problems
Contact customers to respond to inquire or to notify them of claim investigations results and adjustments
Let providers know if wrong codes are used on claims and resubmit claims accordingly
Keep records of customer interactions and transactions Set up Prior Authorizations and Referrals for insurance purposes
Customer Service Representative
IQor Corporation
09/2017 - 06/2019 Columbus, OH
Assist National Grid customers in Rhode Island and Massachusetts regions
Professionally handled customer billing questions, set up payment agreements and scheduled meter changes
Provided payment assistance information to low income households in need
Defused angry customers by efficiently addressing the customer
Maintained 92% attendance rate
SUMMARY
Experienced billing professional in the
healthcare industry, excelling in fast-paced
environments where accuracy and
accountability are crucial. Consistently
models integrity, adheres to policies, and
maintains quality standards. Strong verbal,
written, and interpersonal communication
skills, along with problem-solving and
critical thinking abilities. A valuable team
asset.
EDUCATION
Associates of Science Degree:
Medical Billing and Coding
Ultimate Medical Academy
SKILLS
Medical Billing & Coding EMR
CMS HIPPAA Certified
Greenway Prime Suite
Microsoft Office Imagine
PHIcure NPPES NPI Registry
Claim MD
SOFT SKILLS
Problem-solver High Performer
Self-starter
Effective Communication
Team Player Critical Thinker
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