Alexiyanna Douglas
Ruskin,US
Summary
Hospital, Nursing Facility, Ambulance, Outpatient inpatient health Claims Care Specialist with 9+ years of experience in claims analysis and healthcare support. Proficient in ARDIS, medical terminology, and data analysis, with a strong focus on enhancing claims processing efficiency and reducing denial rates. Known for fostering collaborative relationships with healthcare providers, ensuring seamless communication and timely reimbursements.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Claims Analysts
Humana
Remote
07.2024 - Current
- Analyzed claims data to identify discrepancies, improving accuracy and reducing processing errors for enhanced operational efficiency.
- Maintained comprehensive records of claims submissions, ensuring compliance with regulatory standards and facilitating successful audits.
- Coordinated with healthcare providers to resolve claim issues, fostering strong relationships that contributed to timely reimbursements.
- Conducted trend analysis on claims processing times, implementing strategies that led to noticeable improvements in turnaround efficiency.
- Facilitated cross-functional meetings with stakeholders to address claim discrepancies, strengthening interdepartmental communication and resolution efficiency.
- Executed thorough audits of claims submissions, ensuring adherence to regulatory standards and minimizing potential compliance risks.
Hospital Claims Care Specialist
Navitus Health Solutions / Lumicera Health Services
Remote
09.2023 - 06.2024
- Deliver exceptional service to pharmacy and medical professionals.
- Resolved coverage issues, enhancing claims accuracy.
- Utilized ICD & CPT codes for precise record-keeping.
- Analyzed charts to identify and correct discrepancies.
- Improved claims processing efficiency, reducing denial rates.
- Provided exceptional support to pharmacy teams and prescribers, enhancing collaboration and ensuring seamless communication regarding patient needs.
- Conducted thorough research on plan benefits and prescription coverage, delivering actionable insights that informed decision-making for healthcare providers.
- Remote
Claims Representative
EXL Services
Remote
09.2022 - 08.2023
- Processed life insurance claims, ensuring timely payouts and accurate beneficiary research.
- Resolved payment discrepancies by investigating unpaid claims and deceased beneficiaries.
- Utilized UB-04 and HCFA 1500 forms to streamline claim processing.
- Enhanced accuracy in payouts through diligent case research and estate processing.
- Contributed to efficient claim resolution, improving customer satisfaction and operational efficiency.
- Hospital claims processor
Claims Analyst
Continental Benefits
Tampa Fl
12.2019 - 07.2022
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Participated in ongoing training programs to stay current on industry developments and maintain a strong understanding of relevant laws and regulations affecting the claims process.
Claims Rep
EQ Health Solutions
Remote
09.2018 - 11.2019
- Resolved provider and customer inquiries, ensuring clear communication and satisfaction.
- Managed inbound and outbound calls, addressing medical claim issues effectively.
- Utilized Microsoft Office and databases for case documentation and management.
- Executed administrative tasks, supporting seamless call center operations.
- Improved customer service experience through professional interaction.
- Hospital Claims processor
Claims Rep
Transamerica
Remote
07.2016 - 08.2018
- Answered customer questions regarding Claim updates, updating addresses, policy inquiries, beneficiary information, and services while efficiently processing policies and managing account details.
- Resourcefully responded to customer requests for payment information and added individuals to Life Insurance policies.Provided exceptional customer service by addressing inquiries and resolving issues, enhancing client trust and satisfaction.
- Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
Education
High School Diploma -
Chamberlain Highschool
Tampa, FL01.2015
Skills
- Claims Processing (Experienced), Medical Coding, Medical Billing, ICD-10, CPT Coding, HIPAA, Microsoft Office, Customer Service, Healthcare Management, Data Analysis, Medical Terminology, QNXT, SystemOne, DocsNet, ARDIS, Epic, Claims Management, Benefits Administration, Utilization Review
Certification
CPR Certification
Timeline
Claims Analysts
Humana
07.2024 - Current
Hospital Claims Care Specialist
Navitus Health Solutions / Lumicera Health Services
09.2023 - 06.2024
Claims Representative
EXL Services
09.2022 - 08.2023
Claims Analyst
Continental Benefits
12.2019 - 07.2022
Claims Rep
EQ Health Solutions
09.2018 - 11.2019
Claims Rep
Transamerica
07.2016 - 08.2018
High School Diploma -
Chamberlain Highschool