Adanna ADonis
Tampa,FL
Summary
Diligent Healthcare professional with a demonstrated background in Claims, Appeals and benefit configurations. Team-oriented and reliable with expert healthcare knowledge, clear verbal and written communication skills and sound clinical judgement.
Overview
12
12
years of professional experience
Work History
Benefit Configuration Analyst
Wipro
02.2018 - 12.2024
- Reviews, analyzes and translates diagnostic procedural phrases into coded form
- Configured and maintained medical benefits using NetworX, ensuring accurate claims adjudication.
- Creates testing scripts for new and existing plans. Claim testing
- Developed and maintained pricing rules for various reimbursement methodologies, including DRG, RBRVS, Per Diem, and Capitation models.
- Uses the medical classification system to design the benefit packages with proper ICD-9, ICD-10 CPT-4, HCPCS for configuration into the Peradigm System
- Experience with Institutional and professional medical billing
- Fast learner, Able to handle complex issues
Sr. Claim Analyst and Appeal Coordinator
United Healthcare
02.2017 - 02.2018
- Worked from home remotely
- Demonstrates proficiency in determining if case requires creation of multiple complaint records and reviews correspond to determine classification and sub-type
- Independently reviews the members’ case file to determine if representative/appellant is authorized party and if complaint is valid
- Handled first and second level Claims as well as appeals
- Sends Timely and accurate written correspondence to member, Authorized representative or provider advising of the resolution of their appeal
Claim Processor
Firstsource LLC
01.2016 - 01.2017
- Working with HCFA 1500 understanding Medicaid and Medicare processing guidelines
- Knowledge of HIPPA regulations, HCPCS coding CPT and ICD-9 coding
- Working under pressure to meet processing timeframes while adhering to all productivity and quality requirements
Claims Processor
Staffing Now Agency - Freedom Healthplans
09.2012 - 05.2015
- To process medical claims and perform quality work within deadlines with or without direct supervision
- Working with commercial and Medicare insurance
- Understanding and working with ICD-9 and CPT codes, UB, HCFA 1500, CSM 1500 forms
- Knowledge of Medical Terminology Responsible for fully understanding all lines of business benefits, medical management processes, claim processing, and demographic change processes
Education
practical nursing -
erwin technical college
12.2019
Skills
- Keyboarding (55-60wpm)
- Xcelys
- FACETS
- QNXT
- Networx Pricer
- EPIC systems
- Microsoft Exel
- Fast learner
- Remote work
Gaps In Employment
Any gaps in employment due to full time enrollment in school.
Timeline
Benefit Configuration Analyst
Wipro
02.2018 - 12.2024
Sr. Claim Analyst and Appeal Coordinator
United Healthcare
02.2017 - 02.2018
Claim Processor
Firstsource LLC
01.2016 - 01.2017
Claims Processor
Staffing Now Agency - Freedom Healthplans
09.2012 - 05.2015
practical nursing -
erwin technical college