Summary
Overview
Work History
Education
Skills
Timeline
Soft Skills
Technical Proficiencies
CORE COMPETENCIES
Generic

Danielle Adderly

Sunrise

Summary

Detail-oriented and results-driven
Finance and Healthcare Operations Professional with 6+ years of experience in revenue cycle operations, financial registration, claims analysis, client implementation
support, and data management. Skilled in researching and resolving complex issues, interpreting contracts, validating data, and ensuring accurate financial setup for clients. Proficient in Excel and other Microsoft Office applications with a strong commitment to quality, compliance, and exceptional customer service. Adept at working in fast-paced environments and managing
multiple priorities to meet tight deadlines.

Experienced with operational process improvements and streamlining workflows for efficiency. Utilizes strong problem-solving skills and collaborative approaches to meet organizational goals. Track record of effective resource management and implementing best practices for operational success.

Overview

12
12
years of professional experience

Work History

Claims & Revenue Operations Specialist

UnitedHealth Group (Optum IDR)
Dallas, TX
05.2024 - Current
  • Analyze and review complex healthcare cases in accordance with organizational policies, Medicare/Medicaid guidelines, and regulatory requirements.
  • Research discrepancies, documentation, and billing issues to determine accurate case outcomes and ensure proper application of benefits.
  • Interpret client, provider, and member documentation to validate information and support accurate decision-making.
  • Maintain high productivity and quality while managing 70+ cases daily in a fast-paced remote environment.
  • Collaborate with internal teams, providers, and clients to resolve issues, answer inquiries, and improve workflow efficiency.
  • Utilize multiple systems and databases to research claims, review records, and process case determinations.
  • Perform quality reviews and data validation to ensure accuracy prior to finalizing case decisions.
  • Document findings and decisions in compliance with HIPAA and organizational standards.
  • Identify trends and recurring issues to support process improvement initiatives and reduce operational errors.
  • Provide excellent customer service and clear communication to clients and stakeholders

Claims Adjuster

Certified Medical Consultants
Sunrise, FL
11.2021 - 06.2024
  • Reviewed and analyzed high-volume medical claims for accuracy, coding compliance, and adherence to Medicaid/Medicare and state regulations.
  • Researched and resolved claim discrepancies, documentation issues, and billing errors, ensuring proper application of benefits.
  • Applied appropriate payment adjustments based on policy guidelines, provider contracts, and client requirements.
  • Collaborated with providers, billing departments, and internal teams to obtain supporting documentation and resolve claim issues.
  • Entered and validated claim data in EHR and claims processing systems with a high degree of accuracy.
  • Performed rework on denied or returned claims to ensure timely and accurate resolution.
  • Maintained compliance with CMS, HIPAA, and internal quality control standards.
  • Identified trends in denials and claim issues to support process improvements and reduce rework.
  • Consistently met productivity goals and maintained high-quality performance metrics.

Registered Behavior Technician (RBT)

Spring Health ABA
Boca Raton, FL
06.2023 - 04.2024
  • Delivered 1:1 behavioral therapy services under BCA supervision and implemented individualized treatment plans.
  • Collected and analyzed client data using Rethink EHR system to track progress and program effectiveness.
  • Documented session notes, progress reports, and treatment plans in compliance with Medicaid and HIPAA regulations.
  • Communicated client progress and concerns with clinical teams and families.
  • Supported authorization and billing documentation requirements

Virtual Receptionist

Call Experts
Charleston, SC
01.2017 - 07.2021
  • Managed high-volume calls, scheduling, and intake for 200+ clients daily.
  • Logged client information, routed calls, and maintained accurate documentation.
  • Provided claims intake assistance and ensured clear client communication.

Collections Agent

Alorica
Sunrise, FL
05.2014 - 12.2017
  • Managed delinquent accounts and negotiated payment plans to resolve balances.
    Researched account history, processed payments, and updated CRM systems.
  • Met and exceeded monthly recovery goals in a high-volume call center environment.
  • Complied with FDCPA and company policies while maintaining exceptional service.

Education

High School Diploma -

Broward College
Fort Lauderdale, FL

Associate of Science -

Broward College
Fort Lauderdale, FL

Skills

  • Microsoft Excel (Advanced: VLOOKUP,
  • Pivot Tables, IF Statements, Data Validation, Sorting, Filtering, Charts)
  • Microsoft Office Suite (Excel, Outlook,
    Teams, PowerPoint)
  • Salesforce (CRM)
    SAP AS400
    Electronic Health Record (EHR) Systems
    Work Distribution Tools
  • Oracle / Oracle Fusion (basic)
  • Remote Communication Tools
  • Planning and coordination

Timeline

Claims & Revenue Operations Specialist

UnitedHealth Group (Optum IDR)
05.2024 - Current

Registered Behavior Technician (RBT)

Spring Health ABA
06.2023 - 04.2024

Claims Adjuster

Certified Medical Consultants
11.2021 - 06.2024

Virtual Receptionist

Call Experts
01.2017 - 07.2021

Collections Agent

Alorica
05.2014 - 12.2017

Associate of Science -

Broward College

High School Diploma -

Broward College

Soft Skills

  • Strong attention to detail
  • Analytical thinker & problem solver
  • Excellent written & verbal communication
  • Highly organized & self-Motivated
  • Adaptable in fast-paced environments
  • Committed to compliance & confidentiality
  • Results-Driven with strong work ethic
  • Team Player with a
    client-focused approach

Technical Proficiencies

  • Microsoft Excel (Advanced: VLOOKUP, Pivot Tables, IF Statements, Data
    Validation, Sorting, Filtering, Charts)
  • Microsoft Office Suite (Excel, Outlook,
    Teams, PowerPoint
  • Salesforce (CRM)
  • SAP AS40
  • Electronic Health Record (EHR) Systems
  • Work Distribution Tools
  • Oracle / Oracle Fusion (basic
  • Remote Communication Tool

CORE COMPETENCIES

  • Financial Registration & Client Setup
  • Revenue Cycle Operations
  • Claims Analysis & Adjustments
  • Data Validation & Research
  • Contract Interpretation
  • Client Implementation Support
  • Process Improvement
  • Medicare & Medicaid Guidelines
  • SAP (experience)
  • Excel (Advanced)
  • Cross-Functional Collaboration
  • Client Relations & Communication
  • Audit Documentation
  • HIPAA Compliance