Claims & Denials Management (Medicare, Life, Disability) Team Lead
Resume:
Lorraine Jones
678-***-**** ********@*****.*** Snellville, GA
Experienced Healthcare & Insurance Operations Leader
Professional Summary
Seasoned healthcare and insurance operations professional with over 19 years of experience in medical claims, benefits coordination, and revenue cycle management. Proven ability to lead and train teams, reduce processing errors, and exceed performance goals in fast-paced environments. Skilled in Medicare claims, insurance appeals, and client support. Adept at supervising cross-functional teams, optimizing workflows, and driving results through data-informed decisions and a deep understanding of medical and financial operations. Seeking a management role to leverage operational leadership, analytical precision, and a passion for process improvement.
Core Skills
Claims & Denials Management (Medicare, Life, Disability)
Team Leadership & Staff Supervision
Medical Billing & Coding (ICD-10, CPT, HCPCS)
Excel Reporting & Data Analysis
Customer Service & Client Resolution
Benefits Verification & Authorization
Workflow Optimization & Training
Accounts Receivable / Payable
Regulatory Compliance (HIPAA, CMS)
Excellent Written & Verbal Communication
Professional Experience
Medicare Denial Analyst – CPAR
Hollis Cobb Associates, Duluth, GA Mar 2021 – May 2025
- Reviewed and adjudicated Medicare claims based on payer guidelines and reimbursement schedules.
- Analyzed appeal trends and supported resolution strategies, resulting in a 60% monthly goal overachievement.
- Trained new analysts, streamlining onboarding and process adherence.
- Liaised with Medicare reps to resolve appeals and expedite payment decisions.
Intake Review Coordinator (Contract Lead)
Aerotek at Kaiser Permanente, Duluth, GA Oct 2017 – Mar 2021
- Led intake operations, assigning ICD-10, CPT, and HCPCS codes for pre-certification requests.
- Reviewed benefits eligibility and processed authorizations, surpassing productivity goals by 200%.
- Mentored and trained coordinators; recommended workflow improvements that improved efficiency.
- Resolved denied claims and provided root-cause feedback to reduce future errors.
Customer Care Team Lead
Kelly Services at Assurant LLC, Duluth, GA Jan 2017 – Jun 2018
- Supervised invoice processing (1,200+ per month) and managed insurance support inquiries.
- Performed payment posting, reconciliation, and collections with high customer satisfaction.
- Trained new hires and monitored team quality metrics.
Office Manager
Allied Logistics, Tucker, GA Jun 2006 – Feb 2009
- Oversaw full office operations, including AP/AR, payroll, benefits, dispatching, and HR.
- Created SOPs, negotiated contracts, and implemented payment programs reducing delinquencies by 30%.
- Provided leadership across admin and logistics functions.
Other Roles:
- Front Office Coordinator – Hillandale Medical, Dr. Patil’s Office
- Contract Worker – Hire Dynamics
- Responsibilities across roles included EMR documentation, claims billing, patient relations, and insurance verification.
Education
Medical Billing & Coding Microsoft Suite
New Horizons Medical Institute – Atlanta, GA – 2011
Medical Administrative Assistant
Career Education Institute – Norcross, GA – 2005
Certifications & Training
- HIPAA Compliance
- Medical Terminology & Coding Standards
Notable Achievements
- Trained and mentored over 15 staff across multiple contracts and organizations.
- Consistently exceeded processing and productivity benchmarks (up to 200%).
- Reduced claim denials and improved reimbursement timelines through detailed analysis and collaboration.
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