Data Services & Claims Analyst - Medical Billing Expert
Resume:
Nianna Standifer-Teasley
*********@***.***
Summary
• Accomplished Professional with Data services analyst and Claim analyst
• Proficient in Microsoft Office, word, Power Point, Excel.
• Excellent in Maintains the Provider Data (demographic and contractual) for all network and non- network providers and Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings).
• Skilled in Uses proprietary software tools to access and review claim documents, enter claim decisions, escalations when needed.
Skills: Proficient in Microsoft Office, HIPAA/OSHA Certified, Accurint, Customer Service, Excellent Negotiation Skills Proficient in 10 key entries, Care Radius software, ECM, AuthEntry, Operating Multi- Line Switchboard, Data Entry, ICD-9/ICD-10, CPT Coding, Medisoft, EOBs,COB’s Authorizations, Electronic Remittance Advice/EMR, Medical Terminology, Mediar, Carecentrix, Epremis, AMISYS, CEN PAS, ROI, NextGen, QNXT, EDI/Claim Central, NPPES, QUICKBASE, CITRIX, Acute Care, MedicarePart B,MSC Medicaid, Medi-Cal,CVS portal,MITS,Availity,One Healthport,RDVportal,CM 1500,UB04,Encounter Claims,EMR-SAAS,HER,SQL,Payment Posting,Excel Pivot,NextGen,Epic,ECM/Enterprise content management,EZCAP,SmartAdvisor Education: Medical Insurance Billing & Coding Diploma, Everest College Phoenix-Mesa, 05 / 2012
VOLT WORKFORCE SOLUTIONS 04/2025 -10/2025
Medical Bill Review Specialist
· Process new workers' compensation claims accurately and efficiently in SmartAdvisor
· Maintain detailed records of all claims and related documentation
· Communicate with injured employees, employers, insurance adjusters, and medical providers
· Verify claim information and investigate discrepancies
.Calculate and process benefit payments
· Monitor claim status and follow up on outstanding issues
· Ensure compliance with state and federal workers' compensation laws and regulations
· Prepare reports and statistical data as required
· Assist in identifying potential fraudulent claims
· Maintain confidentiality of sensitive information Professional Partners Group,LLC:
Arizona Asthma & Allergy Institue 01/2025-2/2025
The Medical Records Specialist is responsible for organizing, managing, and maintaining patient health records in accordance with legal, ethical, and organizational policies. This role ensures that all medical records are accurate, up-to-date, and accessible to authorized personnel. The Medical Records Specialist works closely with healthcare providers, administrative staff, and patients to support efficient operations and compliance with regulatory requirements.Record Maintenance:Accurately organize and manage physical and electronic health records.Ensure patient charts and medical histories are updated with the latest information.File, retrieve, and distribute medical records as requested by authorized personnel.Input patient data into electronic health record (EHR) systems.
Amazon Warehouse/ Scanner -11/2024-01/2025 Printing and labeling,sorting and entering information into the computor system 22nd Century Technologies Inc.staffing/Arizona Dept of Revenue Responsibilities: 06/2024
-11/2024
Manning the Unclaimed Property Hotline The first contact and the liaison between Unclaimed Property and its current and potential clients. This position takes ownership for effectively solving customer issues, complaints and inquiries. Specific duties include: • Managing inbound calls in a timely manner • Following call CENTER "scripts” when handling different topics • Identifying customers' needs, clarify information, research every issue and providing solutions Document Control Retrieving, classifying and organizing forms and correspondence, specific tasks include: • Sign for incoming registered or certified mail • Sort and Distribute mail • Produce digital copies of documents for retention purposes • Keep records of incoming packages • Collect and prepare correspondence to be mailed • Correct and forward misdirected mail • Arrange for express delivery when needed Data Entry Quickly and accurately capturing information, specific tasks include: • Transfer data from paper formats into computer files or database systems • Type in data provided directly from customers • Verify data by comparing it to source documents • Update existing data • Retrieve data from the database or electronic files as requested • Sort and organize paperwork after entering data to ensure it is not lost Adecco /JP Morgan Chase/ Data Entry / On Call / Responsibilities: 09/2022 – 05/03/24
• Data Entry operator handles a variety of Receivables Operations functions centered on the processing of data and documentation including documentation review, document handling, document processing, remittance processing, and data entry. This role may involve the physical and electronic handling of information.
As a Data Entry Processor, your responsibilities include, but are not limited to:
· Performing basic data entry including Alpha Numeric
· Logging incoming work
· Sorting, filing, and distributing work, including electronic files, if applicable
· Reviewing incoming documentation/work files,Denials,rejections
· Scanning documents
· Uploading/downloading information to/from systems
· Processing/reviewing transactions
· Maintaining site productivity and quality standards
· Remittance processing, Appeals,Grievance
· Work within the client defined processing guidelines
· Following Standard Operating Procedures
Lifestance Healthcare
Responsibilities:
Medical Billing Specialist-Remote
10/2023-01/2024
Processes various Medicare and Medicaid claim types, including Professional, Facility and Dental claims Accurately analyzes and interprets provider contracts· Researches claims and makes appropriate adjustments System Testing· Assists with system configuration and testing for new clients· Assists with testing of new processes, and provides feedback· Reviews and tests fee schedules Backup Coverage (as requested)· Reviews and approves batch close reports for examiners· Analyzes and authorizes high dollar claims· Determines appropriate payment for claims submitted for reconsideration (payment appeals) Additional Functions:·, Appeals,Grievance,Denials Assists with training new or existing staff, as requested· Responds to clients inquiries related to claims processing· Communicates clearly and concisely, with sensitivity to the needs of others· Follows all Policies and Procedures and HIPAA regulations· Maintains a safe working environment· Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees· Establishes and maintains effective working relationships with co-workers· Participates in any required training sessions/seminars· Participates in special projects as requested Mphasis
Claim Examiner / Analyst / Medical Billing Specialist - Remote 11/2022-09/2023
Responsibilities:
Evaluates claims for completeness and validity to determine payment/denial according to provider contracts, authorizations, and Medicare processing guidelines
· Processes various Medicare and Medicaid claim types, including Professional, Facility and Dental claims Accurately analyzes and interprets provider contracts· Researches claims and makes appropriate adjustments System Testing· Assists with system configuration and testing for new clients· Assists with testing of new processes, and provides feedback· Reviews and tests fee schedules Backup Coverage (as requested)· Reviews and approves batch close reports for examiners· Analyzes and authorizes high dollar claims· Determines appropriate payment for claims submitted for reconsideration (payment appeals) Additional Functions:· Assists with training new or existing staff, as requested· Responds to clients inquiries related to claims processing· Communicates clearly and concisely, with sensitivity to the needs of others· Follows all Policies and Procedures and HIPAA regulations· Maintains a safe working environment· Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees· Establishes and maintains effective working relationships with co-workers· Participates in any required training sessions/seminars· Participates in special projects as requested
Addecco/Epiq
09/22-11/22 Claim Analyst/Remote
Responsibilities:
• Follow written procedures consults with team leadership and peers on case work Uses proprietary software tools to access and review claim documents, enter claim decisions, and create escalations when needed using software Epic,also ECM/Enterprise content management,CRM.
• Communicates immediately to leadership all obstacles to completing work
• Meets and exceeds departmental expectations for accuracy and productivity
• Contributes subject area expertise to determine processing guidelines and assess if standards have been met
• Utilizes documented team processes to ensure compliance with departmental standards
• Data entry and verification, Drafts claimant facing communications based on guidance provided, Communicates directly with claimants by phone or email, Verifies data and processing requirements and makes corrections as necessary, Other projects as assigned also basic math skills Infosys /Molina Healthcare / Avanciers
04/22-08/22
Provider data services analyst
Remote/WFH
Responsibilities:
• Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory.
• Maintains the Provider Data (demographic and contractual) for all network and non-network providers.
• Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings).
• Provides on-going department support in research in Medicare part B in MSC and analysis essential to resolving concerns/issues raised by providers and other internal/external customers, support audit exceptions and resolve issues.
• quality review/assurance in medical claims,Excel pivot,SQL, Encounter Claims
• Meet predetermined production metrics to support claim turnaround times. Provider Network File Tech I/BCBS / Pyramid Consulting, Inc. 12/2021 - 03/2022
Medical Billing Specialist
Remote/WFH
Responsibilities:
Ensure system accuracy of network provider files, based on BCBSAZ standards, as well as federal and state mandated
turnaround time requirements.
Responsible for updating, maintaining and researching a variety of provider file information in multiple systems
Responsible for updating and maintaining the applicable provider file database(s) with documentation submitted.
Responsible for provider contract file research and to recommend appropriate actions and/or maintenance.
Responsible for researching and resolving provider file claims edits, QNXT, EDI/Claim Central
Analyze reports for any data corrections and processes for the Association. Excel pivot,SQL,ROI
Responsible for the review of the provider files for Quality Control.
Each progressive level includes the ability to perform the essential functions of any lower levels.
The position requires a full-time work schedule.
Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
Perform all other duties as assigned.
Experience
Aetna health/quality staffing of America
02/2021 – 11/2021
Provider data services analyst
Remote/WFH
Responsibilities:
• Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory, Medicare part B,MSC, Excel pivot.
• Maintains the Provider Data (demographic and contractual) for all network and non-network providers.
• Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings).
• Provides on-going department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.QNXT,SQL,Excel
• Meet predetermined production metrics to support claim turnaround times.
• Centene corporation
09/2019 – 01/2021
• 1665 W. Alameda Drive #120
• Tempe Az.85282
• CLAIM ANALYST
Responsibilities:
• Follows written procedures and scripts.
• Uses proprietary software tools to access and review claim documents, enter claim decisions, escalations when needed.
• Communicates immediately to leadership all obstacles to completing work.
• Meets and exceeds departmental expectations for accuracy and productivity.
• Utilizes documented team processes to ensure compliance with departmental standards.
• Data entry and verification of information,QNXT and EDI//Claim Central
• Reviews and distributes reports on work assignments, escalations, and/or QA results.
• Drafts claimant facing communications based on guidance provided.
• Verifies data and processing requirements and makes corrections as necessary.
• Grievance and Appeals,Other projects as assigned.
• Medical billing specialist
• CVS /Caremark
05/2017-08/2019
• 444 N.44th Street
• Phoenix Az.85008
Responsibilities:
• Responsible for completing tasks such as billing and maintaining quality and productivity requirements as outlined in the position performance expectations.
• You will process and submit accurate and timely claims to payers, analyze and research unpaid claims, and assist in the resolution of denials, partial payments, and payment variances, Medicare part B,Medi Cal,MSC
• Also will ensure the timely and accurate resolution of outstanding invoices either through collections or adjustments.
• Tri west healthcare alliance
07/2015 –04/2017
• 15810 N.28th Ave
• Phoenix Az.85053
• Medical billing specialist
• Responsibilities:
• Responsible for, reviewing all medical document when returned to ensure that it meets the contractual.
• Requirements for the content with accuracy and to identify critical findings.
• Respond to inquiries from VA and providers, place outbound phone calls, consistently display professional and courteous service.
• Take appropriate steps to comply with HIPAA regulations to protect veteran’s privacy health information.
• Request medical records as directed, also ensure procedures are followed for Authorizations to meet.
• Productivity with minimal errors, also reliable attendance. Rural metro/corporation 12/2012
– 01/2015
8465 N. Pima Rd
Scottsdale Az 85252
Medical biller
Responsibilities: Responsible for, updating pts demographics, verifying pts insurance, signature check, processing claims, prepping Claims to be mailed out, A/R, memo accts, check for denials, Medicare Part B, Medicaid, codes, EOB’s,MSC all accts in Timely Filing. Kachina health claims
03/2012 – 08/2012
Medical biller
Responsibilities:
• Responsible for filing, authorizations, EOBs, processing claims, posting payments, Insurance verifications, and answering phones. Place calls to check on status of claims. Southwest behavioral health
08/2010 –10/2010
Medical records clerk
Responsibilities:
• Responsible for filing, scanning, and analyzing charts, ROI/ request of info from clients, Proofread physician/case manager’s documents for billing purposes. Department of economic security
05/2009 –10/2009
Program service evaluator 1
Responsibilities:
• Take Unemployment insurance initial claims, wage protest, appeals, and resolve issues with customers.
Arizona department of revenue 02/
2001 –02 /2009
Examine tech iii/clerk typist III
Responsibilities:
• Knowledge of office policies and procedures. Responsible for data entry of time sensitive documents.
• Researching files to obtain specific information. Administrative support for multi-line switch board.
• For the department. Examine, update and purge files on the A/R maintenance system.
• Proficient in 10 key entries.
Arizona state hospital
11/1997 – 02/2001
Medical records clerk I
Responsibilities:
• Code and enters medical information.
• Document client referrals to outside clinicians and follows-up To ensure a response is received from outside clinician.
• Reviews patient charts and discharge abstracts, Codes diseases and operations according to standard classifications.
Awards:
• Everest College Phoenix-2011/ Dream Award Recipient
• 10-year Service Award
• 5-year Service Award
• Administrative Support Extra Mile
Contact this candidate