Adoinca Hardy
Jacksonville
Summary
Seeking a position with a company which will require me to utilize my skills, abilities and experience to ensure the company’s success.
Creative problem solver, motivated team player and goal driven achiever with strong analytical skills, detail orientation, extensive research and organizational skills. Understanding insurance regulations, claim denials, and the appeals process Highly knowledgeable and proficient worker bringing many years of experience.
Seasoned Denial Specialist with solid experience in medical billing and insurance claims. Strong understanding of denial management processes, claim reviews, and appeals procedures. Demonstrated ability to work well under pressure while maintaining high attention to detail and accuracy. Proven record of improving efficiency within healthcare financial operations.
Overview
21
21
years of professional experience
Work History
Billing Specialist
Carle
Tampa
08.2024 - Current
- Managing accounts receivable.
- Requested medical authorization.
- Billed medical claims to different insurance companies.
- Posted payments.
- Managed insurance claims submissions and follow-ups for timely payments.
- Coordinated with healthcare providers to resolve billing discrepancies.
- Reviewed billing documentation for compliance with policies and regulations.
- Collaborated with collections team to address overdue accounts effectively.
- Investigated incorrect billings and processed refunds as necessary.
- Maintained accurate records of collections, adjustments and denials in the system.
- Calculated billing charges, prepared and submitted claims to insurance companies.
Medicaid State OPS Analyst
Amerigroup
06.2009 - Current
- Researches, analyzes and adjudicates claims resubmitted because of denial problems, incorrect payment, contract issues, appeals and grievances to determine if the claim is payable.
- Anticipates and recognizes problems associated with processing of complex claims, which may include a variety of elements requiring independent judgment.
- Consistently evaluates applicable policies and procedures and recommends changes as appropriate.
- Performs special projects as requested.
Service Associate IV
Blue Cross and Blue Shield of Florida
12.2004 - 05.2009
- Provided a customer friendly service experience for both members and providers with questions regarding health care, health insurance (benefits, claims, premium payments, and enrollment) or other related topics.
- Responded to telephone, web-based inquiries, and mailed written correspondence and initiated telephonic follow-up when appropriate.
- Used web-based tools and other aids to facilitate and teach customers to use resources, tools, information on their health care and health care costs most effectively.
Education
Medical Billing and Coding -
Ultimate Medical Academy
01.2013
Computer Technology -
Advance Career Center
01.2001
Diploma -
Andrew Jackson High School
01.1997
Skills
- Microsoft Word
- Excel
- Power Point
- Internet Explorer
- EPIC
- Macess
- Facets
- Typing 60 words per minute
- Accounts receivable
- Medical billing
- Insurance claims
- Customer service
- Data entry
- Problem solving
- Regulatory compliance
- Attention to detail
- Analytical thinking
- Team collaboration
- Communication skills
- Insurance confirmation
- Multitasking and organization
- HIPAA compliance
- Data research
References
Available Upon Request
Timeline
Billing Specialist
Carle
08.2024 - Current
Medicaid State OPS Analyst
Amerigroup
06.2009 - Current
Service Associate IV
Blue Cross and Blue Shield of Florida
12.2004 - 05.2009
Medical Billing and Coding -
Ultimate Medical Academy
Computer Technology -
Advance Career Center
Diploma -
Andrew Jackson High School