Reimbursement Advocate
Resume:
DONNA DUNBAR
*********@*****.***
Dallas, TX
https://www.linkedin.com/in/donna-dunbar-102438194
SUMMARY OF QUALIFICATIONS:
•Administrative, Workers Compensation Claims, Insurance, Healthcare Billing, Account Management
•Knowledge of Microsoft Word, Outlook, Epic, Salesforce, PowerPoint, Excel, Careworks, Image Right
PROFESSIONAL EXPERIENCE
Contract Work:
SNI Staffing – Claims Coordinator (July 2023 – June 2024)
Provided administrative support to the risk management department
Managed workers compensation and liability claims
Ensured all claim documents were completed, processed, and reviewed for accuracy
Assisted with claim inquiries, providing prompt and accurate responses
Scheduled meetings, appointments, and managed calendars
Entered and updated claims data into department database
Inogen Oxygen – Reimbursement Advocate (Feb. 2020 – Feb. 2023)
Worked with Medicare, Medicaid, Commercial Insurance, and Private Pay to ensure medical claims are being processed timely and paid accurately.
Ensured the billing of all claims via electronic to Medicare, Medicaid, and Commercial Insurance payers are being submitted accurately and timely.
Responsible for assisting patients, doctors, customers, and coworkers with billing inquiries with highest level support.
Captured, investigated and responded to all complaints regarding customer grievances and appeals involving provision of service and benefit coverage issues.
Ensured appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs; ensured appropriateness of the response in compliance with State and Federal guidelines.
Prepared response letters, notifications, and acknowledgements for members and provider complaints, grievances and appeals.
Ensured all billing systems are updated timely with patient demographics, payer information, and notated appropriately.
Gathered, prepared, and submitted required information and/or documentation to appeal claim denials.
Ensured that appropriate medical records are maintained according to HIPPA guidelines.
Ensured the timely procurement of all required documentation and obtain authorizations to prevent future denials of claims.
Analyzed payer claim rejections & denials to help determine root cause and prevention of future rejections & denials from reoccurring.
Amerisure - Workers Compensation Claims Coordinator (March 2016- Sept. 2019)
Managed over 150 Workers Compensation claims to evaluate compensability.
Planned and conducted initial claim preparation and established reserve requirements as necessary.
Collected information from insureds and injured workers in connection with worker compensation.
Processed claim documents and inquiries related to insurance claims for multiple lines of business and other coverage types.
Provided status and made payments for worker compensation claims to healthcare providers.
Entered claim information regarding medical treatment and claimant injury into database.
Documented calls and created solutions to resolve missing or delinquent payments in system.
Responded to activities set by billing coordinators for assigned accounts.
Collaborated with billing department to resolve internal billing issues.
Requested medical records from designated healthcare providers for medical exams and verified attendance.
Verified coverage via internal system and attached supporting documents to claims.
Provided invoice processing for accounts payable for the claim and/or recovery department.
Purchasing Management - Document Specialist / Executive Assistant (March 2014 – March 2015)
•Assisted in preparing proposals and contracts for project planning of hotels & casinos.
•Provided administrative support, scheduled meetings, managed calendars and correspondence.
•Coordinated onboarding new employees and preparing orientation materials.
•Prepared spreadsheets for marketing business and keeping track of accounts.
•Responsible for compiling introductory and welcome brochures and letters for new business.
•Organized and created marketing tools for distribution.
•Prepared travel arrangements and detailed travel itineraries.
•Assisted in scheduling interviews and sent appropriate resumes to hiring managers.
EDUCATION
University of Texas, Tyler, TX Bachelor of Science in Political Science
Texas All Lines Adjuster License
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