Medical Records Billing Specialist

Tonia Daniels

Dallas, TX

Professional Summary

Experienced Medical Records and Billing Specialist with over 20 years of demonstrated success in healthcare revenue cycle management, medical records coordination, and claims processing. Currently serving as a Medical Records Specialist at Witherite Law Group, efficiently managing complex requests for hospital, ER, and radiology billing while ensuring compliance with HIPAA and regulatory standards. Proficient in a wide range of billing and records software. Adept at resolving discrepancies, facilitating lien management, and collaborating across departments to optimize workflow and maximize reimbursement. Recognized for strong organizational skills, attention to detail, and the ability to perform effectively under pressure in fast-paced environments.

Authorized to work in the US for any employer

Work Experience

Medical Records Specialist

Witherite Law Group-Dallas, TX

April 2024 to July 2025

• Managed comprehensive requests for Initials on non LOPs (Letters of Protection), including hospital billing, medical records, ER physician billing, and radiology billing, ensuring all documentation was accurate and delivered within strict deadlines to support legal case development.

• Conducted detailed redactions of sensitive and confidential medical information in compliance with HIPAA and organizational policies, reducing legal risk and maintaining client confidentiality.

• Collaborated closely with healthcare providers, insurance companies, and legal teams to verify medical records, clarify billing details, and resolve discrepancies to support case integrity and expedite claims processing.

• Assisted as needed in the Liens department by preparing lien documentation, verifying outstanding balances, and coordinating communication between medical providers and legal representatives to ensure accurate and timely resolution of lien claims.

• Monitored and managed case development workflows, prioritizing requests based on urgency and complexity to meet or exceed turnaround times and support organizational goals.

• Developed and maintained detailed logs and reporting tools to track status of medical records requests, redactions, and lien follow-ups, providing actionable insights to management for process improvements.

• Assisted in the Medical Review department, as needed requesting Non Lop’s & Lop’s. Also assisted in scheduling the Clients with there appointments for therapy, etc. RCM Specialist (Advocate)

Jefferson Dental & Orthodontics-Carrollton, TX

June 2023 to January 2024

• Submitted insurance claims accurately and promptly through DentalXChange, ensuring all necessary documentation was attached and compliant with payer requirements to maximize first-pass claim acceptance.

• Thoroughly reviewed insurance Explanation of Benefits (EOBs) for correctness of payments, identified discrepancies, and initiated timely corrections or appeals to recover underpayments or denied procedures.

• Maintained clean patient ledgers by entering adjustments for non-appealable denials and ensuring accurate account balances.

• Proactively managed aging reports to track unpaid claims, collaborated with insurance providers and internal departments to resolve issues, and reduced days in accounts receivable.

• Served as a primary point of contact for patients regarding billing inquiries, payment plans, and collections, demonstrating strong customer service skills to improve patient satisfaction and compliance.

• Assisted in staff training and cross-department collaboration to streamline claim submission workflows and enhance overall revenue cycle performance.

• Generated and analyzed reports on payer trends and denials, providing actionable recommendations to management for process improvements.

Refunds Specialist

Star Dental Partners (contract)-Plano, TX

November 2021 to March 2023

• Processed refund requests from over 40 dental offices with meticulous attention to detail, ensuring accurate and timely refunds to patients, insurance companies, and third-party payers via multiple payment platforms (Check, CareCredit, US Pay).

• Collaborated closely with the Accounting Department during month-end closing by extracting, reconciling, and analyzing financial data from Dentrix, Softdent, and Eagle Soft Practice Management Systems to support accurate financial reporting.

• Maintained organized and efficient mail handling procedures, including sorting, distributing, and managing outgoing payments, ensuring secure and timely delivery.

• Verified payment status in Acumatica and proactively researched and resolved any discrepancies or outstanding invoices to avoid payment delays.

• Served as a liaison between dental offices, accounting, and patients to address refund inquiries and resolve issues promptly, improving communication flow and customer satisfaction.

• Assisted with audit preparation by maintaining clear documentation of refund processes and transactions.

• Identified opportunities to improve refund processing workflows, contributing to enhanced operational efficiency.

Credentialing Analyst (Remote)

AMN Healthcare (temp assignment) Coppell, Tx-Remote August 2021 to October 2021

• Processed and verified provider credentialing information in strict accordance with company policies and regulatory requirements to support network development and credentialing workflows.

• Assisted in the preparation, coordination, and submission of provider documentation to managed care quality committees, internal departments, and external regulatory entities to ensure timely approvals and compliance.

• Maintained and updated the credentialing database, accurately tracking all direct provider contract data and ensuring records were complete and current.

• Conducted primary and secondary source verifications of provider credentials, licenses, and certifications following departmental and industry standards.

• Managed maintenance of all essential documentation, including medical licenses, Drug Enforcement Administration (DEA) registrations, and malpractice insurance coverage for physicians and mid-level providers.

• Ensured ongoing compliance with national accreditation standards and quality organization requirements to support organizational credentialing integrity and provider eligibility. Collection Specialist-Home Infusion

Advanced Infusion Solutions-Farmers Branch, TX

June 2019 to May 2020

• Conducted timely follow-up on aging claims (30, 60, 90+ days) through websites and phone outreach to ensure prompt payment and resolution.

• Investigated and worked denied claims by preparing and submitting appeals and reconsideration requests to facilitate claim approval.

• Processed claim adjustments as necessary and managed all related correspondence to maintain accurate account records.

• Resubmitted claims via Zirmed platform when required to comply with payer guidelines and expedite payment.

• Sent prescription (RX), compound receipts, and AIS letters as requested to support claim processing and regulatory requirements.

• Utilized Lynx system to locate and verify medication and prescription information for accurate claim management.

Full Cycle Billing Specialist- DME

In Home Products-Farmers Branch, TX

April 2017 to March 2019

• Managed Medicare, Texas Medicaid, Commercial, and Managed Medicare Durable Medical Equipment

(DME) claims from submission through payment.

• Posted insurance payments accurately, both electronically and manually, ensuring timely and correct account updates.

• Submitted claims electronically and via paper when necessary, ensuring compliance with payer guidelines and timely filing deadlines.

• Reviewed and worked accounts receivable aging reports, focusing on claims aged 60+ days to improve cash flow.

• Conducted thorough follow-up on denied or underpaid claims, preparing and submitting appeals and reconsiderations to maximize reimbursement.

• Processed patient payments by check and credit card, issuing receipts and maintaining accurate payment records.

• Generated and mailed monthly patient statements to ensure clear communication and timely payments.

• Performed small balance and bad debt write-offs in accordance with company policy to maintain accurate financial records.

Education

South Oak Cliff High School

Skills

• Medical Records Management & Requests (10+ years)

• Medical Software & Systems: Metrix, Eprimis, Star, HPF, Bright Tree, Centricity, Availity, Navinet, Integrity, Dentrix, Softdent, Eagle Soft, Acumatica, SAP, Epic, NextGen (10+ years)

• Lien Documentation & Coordination (10+ years)

• Medical Billing & Coding (ICD-9, ICD-10, CPT, HCPCS) (10+ years)

• HIPAA Compliance & Confidentiality (10+ years)

• Accounts Receivable & Payable (10+ years)

• Team Collaboration & Cross-Department Coordination (10+ years)

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