Danett Pendleton
Tallahassee,FL
Summary
Experienced Healthcare Technology and Operations Specialist with over 10 years in claims processing, provider support, and administrative systems. Skilled in navigating EMR platforms, insurance platforms, and HIPAA-compliant workflows. Currently pursuing CompTIA Network+ certification and developing hands-on networking skills in environments involving Cisco tools, firewalls, and Windows Server administration. Seeking to leverage deep healthcare experience and technical growth into a Senior Network Specialist role focused on infrastructure support and systems integration.
Overview
14
14
years of professional experience
Work History
Insurance Claims Processor
Oscar Health
07.2022 - Current
- Develop an excellent grasp of the Administrative Operations system and overall workflows.
- Develop a comprehensive understanding of the current review processes that currently exist and additional processes needed to improve consistency and quality of review.
- Contribute to the reduction of the daily inventory.
- Support the Administrative Ops team by identifying issues and presenting resolutions.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Take ownership of monitoring, tracking and status of all work-in-progress issues.
- Manage the escalation and resolution process with external vendors to ensure appropriate turnaround times (where applicable).
- Contribute to team wide goals to improve processes and integrate additional functions into our daily operations.
Claims Resolution Lead
Gainwell Technology
07.2018 - 06.2022
- Develops and implements general insurance and health policies in accordance with state and federal laws.
- Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions.
- Responds to provider appeals and meets with providers to resolve problems/issues.
- Provides directions for utilization review.
- Approves any remedial or recoupment actions associated with escalated claims.
- Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs.
- Self-motivated, with a strong sense of personal responsibility.
Insurance Verification/Team Lead
Community Health Centers
10.2015 - 07.2018
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Collaborated with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
- Managed schedules, accepted time off requests and found coverage for short shifts.
- Optimized customer experience by delivering superior services and effectively troubleshooting issues.
- Collected, arranged, and input information into database system.
- Conducted regular reviews of operations and identified areas for improvement.
- Created and managed project plans, timelines and budgets.
Patient Service Representative
Community Health Centers
09.2014 - 10.2015
- Close and ensure that all billing claim codes are correct.
- Complete end of day reports to ensure accuracy of monetary fees.
- Managed patient registration process, confirming data accuracy and completeness.
- Facilitated patient registration by accurately entering demographic and insurance information into electronic health record systems.
- Assisted patients in filling out check-in and payment paperwork.
- Took copayments and compiled daily financial records.
- Coordinated referrals efficiently between primary care providers and specialists, ensuring a seamless patient experience.
- Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
Patient Service Representative/Medical Records
The Family Health Center of Columbia County
10.2011 - 09.2014
- Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements.
- Verified insurance eligibility and coverage for patients.
- Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic.
- Filed and maintained patient records in accordance with HIPAA regulations.
- Provided exceptional customer service to patients, answering questions and addressing concerns.
- Improved patient satisfaction by providing exceptional customer service during check-in and check-out processes.
Education
High School Diploma -
Columbia High School
Lake City, FL06-2001
Allied Health Medical Assistant - undefined
City College
Gainesville, FL01.2013
Associate - Business Administration
Colorado Technical University
01.2018
Skills
- Healthcare Ops: Medical Coding (ICD-10/CPT), Billing, Insurance Verification
- Systems & Administration: Windows Server, Active Directory, Linux (basic), Microsoft 365, Group Policy
- Monitoring & Security: Wireshark, SolarWinds, HIPAA Compliance, Network Access Control
- Cloud & Virtualization: AWS VPC (basic), Azure Network Security Groups (basic), Remote Desktop Tools
- Support & Collaboration: Jira, ServiceNow, Zendesk, Ticket Escalation, SOP Documentation, Team Training
- Healthcare & Administrative: eClinicalWorks, NextGen, Medical Manager, Medical Billing, Insurance Verification, ICD-10/CPT Coding, Affordable Care Act Navigation
Timeline
Insurance Claims Processor
Oscar Health
07.2022 - Current
Claims Resolution Lead
Gainwell Technology
07.2018 - 06.2022
Insurance Verification/Team Lead
Community Health Centers
10.2015 - 07.2018
Patient Service Representative
Community Health Centers
09.2014 - 10.2015
Patient Service Representative/Medical Records
The Family Health Center of Columbia County
10.2011 - 09.2014
Allied Health Medical Assistant - undefined
City College
High School Diploma -
Columbia High School
Associate - Business Administration
Colorado Technical University
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