Insurance Claims & Eligibility Specialist

DENISHA EDWARDS

Canton, MS ***** · 769-***-****

***************@*****.***

OBJECTIVE: To obtain a rewarding and challenging position that utilizes my skills as well as provide opportunities for personal and professional growth, helping build my team and the company.

EXPERIENCE

03/2025-PRESENT

PRE-ARRIVAL UNIT REPRESENTATIVE, University of MS Medical Center

Verify patient insurance eligibility and coverage.

Maintains strict confidentiality and adheres to all HIPAA guidelines and regulations.

Leverage available information (e.g., CPT codes, diagnosis codes) to obtain authorizations.

Obtain approval for services scheduled by external providers.

Pre-certify services requiring authorization in a timely and efficient manner.

Timely pre-certify outpatient procedures when applicable.

Complete Notification of Admission (NOA) promptly to notify relevant payers about patient admissions.

Communicate with patients, insurers, and relevant parties regarding insurance verification and authorization.

Communicate updates and address questions on work progress to team members, leadership, and external departments.

Strong written and verbal communication skills.

06/2017 -03/2025

CLAIMS REPRESENTATIVE ASSOCIATE, Unitedhealthcare

Responsible for providing expertise to teams in reviewing daily work

Conducts data entry and re-work with a focus on quality

Provides reports as necessary, maintaining strong communication with Subject Matter Experts and leadership

Learn and use new systems/applications resources as needed

Process Medicaid and Medicare Claims for several states, including behavioral, medical, and hospital claims among others

Protect members and providers by keeping claims information confidential

Document medical and hospital claims actions by completing forms and reports, tracking production, and keeping records

Resolve medical and hospital claims by approving or denying claims submissions, calculating benefits, and initiating payments

Claims Outcome Task Force training

Call providers with the ability to develop a relationship in a short conversation with them

Problem solves non-standard requests

Ability to work in any state plan for each call campaign with little to no training

Organize and follow through on any projects, making sure to comply with contract standards ensuring timely payment

02/2008 – 06/2017

ADMINISTRATIVE ASSISTANT, Electro national corporation

Assistant to the president

Participated in a variety of assigned departmental assignments

Answered incoming calls and distributed messages as appropriate; maintained receptionist area

Opened, stamped, and distributed incoming mail while recording pertinent information

Responsible for all invoices to customers

Welcomed visitors by greeting them, in person or on the telephone, answering and referring inquiries

Directed visitors by maintaining employee and department directories; gave instructions

Maintained telecommunication system and console operation

Maintained safe and clean reception area by complying with procedures, rules, and regulations

Maintained continuity among work teams by documenting and communicating actions, irregularities, and continuing needs

Contributed to team effort by accomplishing related results as needed

Utilized Microsoft Office in daily tasks and responsibilities

01/2006 – 01/2008

PRODUCTION WORKER, Electro National corporation

Worked on assembly line with a focus on quality

Prepared tags for tubes to be shipped out

Cleaned out tubes with a pressure washer

Bent tubes and sorted wires, maintaining a clean workspace

Documented all jobs that were completed in a timely manner

EDUCATION

BACHELOR OF SCIENCE 2016

HEALTHCARE ADMINISTRATION, Jackson State University

ASSOCIATES DEGREE 2010

MEDICAL OFFICE TECHNOLOGY, Holmes community college

SKILLS

Assertive, self-motivated, goal-oriented, organized, and efficient

Flexible, cooperative, hard worker, team player, and reliable

Communicates clearly and concisely both orally and written

Extensive knowledge of medical terminology, excellent people skills and willingness to work well with others

Data entry, medical manager office program, MS Excel, MS Word, transcription, typing 65+ WPM

Proficient in Epic electronic medical record system, with experience in clinical documentation, order entry, and patient workflow optimization.

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