Adanna Adonis
Tampa,FL
Summary
Benefit Configuration Analyst with extensive experience in claims processing, appeals coordination, and medical claims examination. Proficient in QNXT configuration, ICD and CPT coding, and analyzing complex diagnostic data. Strong communicator and team collaborator with expertise in predictive analytics and regulatory compliance, driving efficient and accurate claims resolutions.
Overview
12
12
years of professional experience
Work History
Benefit Configuation Analyst
WIPRO
03.2018 - 03.2024
- Reviews, Analyzes and translates diagnostic procedural phrases into coded form.
- Create testing scripts for new and existing plans.
- Design, build and test configurations in support of business requirements.
- Experienced QNXT configuration and claims processor.
- Enhanced team collaboration by providing clear communication of complex findings through visualizations and reports.
Senior Claim Analyst and Appeal Coordinator
United Healthcare
02.2017 - 02.2018
- Demonstrates proficiency in determining if cases requires creation of multiple complaint records and reviews correspond to determine classification and sub-type.
- Experienced QNXT claims processor
- Handled first and second level claims as well as Appeals
- Sends timely and accurate written correspondence to member, Authorized representatives or provider advising of the resolution of their appeal.
Medical Claims Processor
First Source LLC
06.2015 - 01.2017
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Understanding and working with ICD and CPT codes
- Working with Commercial and Medicare Claims
Senior Medical Claims Examiner
Staffing Now Agency
09.2012 - 05.2015
- Expertly navigated disputes between parties involved in the claiming process, leading to fair resolutions.
- Reduced claim denial rates by thoroughly reviewing and validating medical documentation before submission.
- Experience with UB, HCFA 1500, CSM 1500 forms.
- Knowledge of all medical terminology responsible for fully understanding all lines of business benefits, medical management processes, claim processing and demographic changes.
Education
Practical Nursing - Nursing
Erwin Technical College
Tampa, FL12.2019
High School Diploma -
Wharton High School
Tampa, FL05.2006
Skills
- Analytical Thinking, Self Starter with ability to handle multitasking in fast paced environment
- Professional with MS Excel
- Team Collaboration and Leadership
- Documentation And Reporting
- Experience with QNXT, Xcelys, Citrix
Timeline
Benefit Configuation Analyst
WIPRO
03.2018 - 03.2024
Senior Claim Analyst and Appeal Coordinator
United Healthcare
02.2017 - 02.2018
Medical Claims Processor
First Source LLC
06.2015 - 01.2017
Senior Medical Claims Examiner
Staffing Now Agency
09.2012 - 05.2015
Practical Nursing - Nursing
Erwin Technical College
High School Diploma -
Wharton High School