Data Entry Project Management

Claudia Dabney

Lanham, MD ***** 301-***-**** **********@*******.*** www.linkedin.com/in/claudia-d-754266a0

DIRECTOR OF CLAIMS MANAGEMENT

Medical Claims Management Project Management Medical Insurance Billing and Coding Concierge Services

Knowledgeable and accomplished medical claims management professional with experience in the healthcare insurance industry. Proven leadership, management and supervisory skills. Expertise in medical records systems, customer service, budget development, process improvement, and insurance billing procedures.

Key Skills

Developing Budgets Team Coaching/Mentoring Supervision Staffing Project Management Management Proficiency Process Improvement Tracking Budget Expenses Performance Management Inventory Control

Medical Billing and Coding Payment Posting ICD-9-CM HCPCS CPT Introduction to ICD-10-CM Insurance Verification Co-Payments and Deductibles HIPAA Compliance Government Payers Medicare Medicaid Tricare Third- Party Payers CMS 1500 CMS 1450 (UB-04) EOB's Electronic Medical Records (EMR/EHR) Worker's Compensation Managed Care (HMO PPO POS) Office/Practice Management Insurance Billing Procedures Visio Access Medical Office Procedures Strong presentation and facilitation skills 10+ years of experience in employee training

Key Achievements

Recipient of PHW’s 2024 Beyond the Call of Duty Leadership Award: recognized Leader who inspires, influences, acting as a role model for others to follow in the workplace and community.

Invested in members of my team by providing coaching opportunities to realize their true potential.

Developed and delivered training curriculum for new hires, resulting in an overall increase in onboarding efficiency and improved team performance.

Professional Experience

Harmony at Enterprise, Bowie, MD 07/2024 – Present

Concierge (Part Time)

Delivers courteous and professional front desk service, including call transfers, message handling, and visitor greetings to maintain a welcoming environment.

Logs and processes service requests for residents and staff, ensuring timely follow-up and resolution.

Maintains cleanliness and organization of the front desk and lobby area to uphold community standards.

Monitors building security by managing resident and visitor logs, conducting periodic checks of entrances/exits, and reporting concerns as needed.

Attends staff meetings and in-service trainings to stay informed of community policies and procedures.

Supports daily operations by completing additional duties as assigned, contributing to a safe and efficient environment.

Pennsylvania Health and Wellness (Centene Corporation), Remote 06/2017 – 02/2025

Senior Manager, Claims and Contract Support

Acted as Subject-Matter Expert (SME) for the Community HealthChoices (CHC) Long-Term Services and Supports (LTSS) program, providing guidance on policy interpretation and implementation.

Provided oversight on the implementation of several provider value-based incentive programs which offered providers an additional incentive payment for remaining compliant with specific state mandated metrics.

Hired and provided day to day guidance to a dedicated team of qualified individuals that developed and managed the Pennsylvania Health and Wellness' (PHW) provider network ensuring that all processes aligned with organizational goals and regulatory standards.

Claudia Dabney 301-***-**** Page 2

Pennsylvania Health and Wellness (Centene Corporation), Remote (Cont’d) 06/2017 – 02/2025

Senior Manager, Claims and Contract Support

Created and managed team who established a robust credentialing process to verify provider qualifications and maintain compliance with regulatory standards, ensuring high-quality care delivery.

Recognized for developing a Comprehensive Multi Specialty Provider Network which offers comprehensive care options.

Introduced Automation opportunities by utilizing automated claims management solutions to streamline the configuration and testing of benefits and provider claims.

Concentrated development efforts on minimizing errors and expediting the reimbursement process which exceeded established organizational metrics.

Instrumental in the health plan consistently achieving/exceeding medical claims being processed in 7 days which exceeded corporate and state metrics turnaround time of 30 Days.

Immigration and Customs Enforcement (ICE) Health Service Corps, Washington, DC 11/2002 – 06/2017

Provider Relations Manager

Employed as a Subject-Matter Expert (SME) to conceptualize a Medical Claims Management Program for ICE Health Services Corps under Department of Homeland Security, a $72 Million program which provided medical care to approximately 33,000 detainees custody as well as approximately 360,000 persons apprehended by U.S. Customs and Border Protection each year and achieved an 86% cost savings.

Partnered with vendors to establish/implement interoperable electronic health record (EHR) system to facilitate seamless data exchange between providers.

Enhanced accuracy in claims processing and patient record management; as well as the Medical Payment Authorization Requests (Med PAR) system.

Served as the Administrator of the ePharmacy Prime Vendor program and worked with the Contracting Team to negotiate contracted rates on behalf of IHSC.

Responded to Congressional inquiries, Office of Inspector General (OIG) reviews, and internal requests regarding detainee care and medical claims reimbursement.

Education

Bachelor of Science (BS), Biblical Studies

Jericho Christian College

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