AYANNA NELSON
Dallas,TX
Summary
Professional with strong background in claims management and collections. Demonstrates high level of competency in resolving complex issues, ensuring compliance with policies, and maintaining accurate records. Known for exceptional teamwork, adaptability, and consistently achieving positive outcomes. Skilled in negotiation, communication, and detailed analysis, with commitment to supporting organizational goals and improving processes.
Overview
10
10
years of professional experience
Work History
Appeals Specialist III
Aspirion Healthcare (remote)
03.2023 - Current
- Evaluated and processed complex healthcare claims, ensuring compliance with regulatory standards
- Run claim data through various pricing software
- Utilized medical coding software to support claims processing efficiency
- Developed training materials to support new employee integration and knowledge retention.
- Facilitated seamless onboarding processes for new hires, enhancing initial employee experience.
- Led cross-functional teams to streamline claims processing workflows, enhancing operational efficiency.
Claims Analyst Supervisor
Healthcare Revenue Solutions
02.2022 - 02.2023
- Responsible for ensuring team meets or exceeds performance metrics in compliance with objectives
- Research, investigate, and recover revenue from aged healthcare claims using the Federal ERISA appeal process
- Review previously processed, written-off, and unresolved medical claims to maximize recovery of underpayments
- Interface critical research tools for complex audits review
- Analyzed denial trends to develop strategic initiatives that improved the overall claims approval rate
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Ensured accurate record-keeping by conducting regular audits of personnel files and HR databases.
- Updated HR database with new employee information, changes in benefits, and other details.
- Conducted comprehensive interviews to assess candidate qualifications and cultural fit.
Patient Account Specialist II
Children’s Health Medical Center (remote)
03.2018 - 02.2022
- Performed high-dollar account follow-up and collections for account balance variances on Commercial and Transplant claims
- Researched and identified payer issues and trends resulting in bulk claim underpayments
- Maintained patient records, detailing patient treatments and diagnosis
- Verified and updated coding and demographic errors
- Coordinated with healthcare providers to verify covered benefit plan treatments and clinical authorizations
- Drafted claim appeals to support medical necessity and authorization related claim denials
- Utilized denial management software to track and manage claim issues, streamlining processes
- Facilitated communication between patients and insurance providers to streamline claims processing.
Patient Account Representative
Baptist Health Medical Center
08.2017 - 02.2018
- Monitored outstanding hospital-clinic accounts
- Analyzed, verified, and resolved patient records and insurance information on patient accounts
- Reviewed and processed insurance files, applied charges, investigated, and resolved patient discrepancies
- Resolved accounts that are in billing and collecting for charges to insurance companies, and consistently responded to third party payer inquiries
- Managed patient accounts by accurately processing insurance claims and coordinating benefits with payers
Customer Service Representative
Southeastrans
01.2016 - 06.2017
- Provided exceptional customer service by handling inquiries and concerns related to Medicaid transportation services
- Assisted clients in scheduling transportation appointments, ensuring timely and accurate service delivery
- Conducted comprehensive eligibility assessments and determined client eligibility for Medicaid programs
- Maintained up-to-date knowledge of Medicaid regulations and policies to provide accurate information to clients
Dietetic Technician
University of Arkansas Medical
05.2015 - 12.2015
- Assisted registered dietitians in developing personalized meal plans for clients with specific dietary needs
- Collaborated with healthcare teams to implement dietary interventions for patients with chronic diseases
- Conducted nutritional assessments and documented dietary intake for patients in a clinical setting
Education
Associate of Arts - Psychology
University of Pulaski Tech
Little Rock, AR05.2015
Skills
- Claims Handling Policy
- Interpretation, Coverage Verification, Pre-Authorization
- Software: Microsoft Office (Suites) (Excel, Access, Word)
- Regulatory Compliance: HIPAA, ICD-10, CPT Codes, HCPCS, Affordable Care Act, ERISA
- EHR Software: EPIC, Cerner, Paragon, Meditech
- HR policies development
- Talent acquisition
- Employee relations
- Performance tracking
- Onboarding and orientation
Timeline
Appeals Specialist III
Aspirion Healthcare (remote)
03.2023 - Current
Claims Analyst Supervisor
Healthcare Revenue Solutions
02.2022 - 02.2023
Patient Account Specialist II
Children’s Health Medical Center (remote)
03.2018 - 02.2022
Patient Account Representative
Baptist Health Medical Center
08.2017 - 02.2018
Customer Service Representative
Southeastrans
01.2016 - 06.2017
Dietetic Technician
University of Arkansas Medical
05.2015 - 12.2015
Associate of Arts - Psychology
University of Pulaski Tech
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