Danielle Cummings
Marysville,WA
Summary
Dynamic and results-driven Insurance Follow-Up Lead at UW Medicine, skilled in EPIC software and team collaboration. Proven track record in resolving complex claims and enhancing revenue through effective appeals processing. Adept at maintaining confidentiality while delivering exceptional service, ensuring timely resolutions, and fostering a positive communication environment.
Overview
20
20
years of professional experience
Work History
Insurance Follow-Up, Lead
UW Medicine
Seattle, Washington
10.2022 - Current
- Assist the Manager and Supervisor with any special projects or tasks that routinely develop. Ensure completion on a timely basis.
- Assist Insurance Follow-up Specialists with problem accounts in their work queues, including problems working with difficult payers.
- Work timely and accurately in assigned claims follow-up queues, and other assignments.
- Accurately decipher the denial reason, and prospectively plan follow-up steps.
- Effectively communicate in writing and verbally with payers. Knowledge of one-on-one instructional techniques.
- Utilize epic functions to work on claims (including selecting the appropriate appeal letter, NRP action, adjustment versus void action).
- Maintain a clear and concise narrative on the practice management system of steps taken to facilitate the resolution of outstanding claims/issues.
- Maintained confidentiality and handled sensitive information with solid judgment and discretion.
- Display sound judgment in choosing the method of follow-up (including appeal, adjustment, e-mail, websites, and telephone inquiries).
- Share specific payer and coding information with team members, as appropriate.
- Work collaboratively with Practice Advisors and other UWP departments, including Compliance, Charge Capture, and Payment Posting.
- Respond satisfactorily and in a timely manner to requests from Patient Account Representatives regarding questions from patients and their advocates.
- Create an atmosphere that maximizes communication; this includes adjusting for different communication styles.
Insurance Follow-Up Specialist
UW Medicine
Seattle, WA
03.2016 - 10.2022
- Contributed ideas and solutions to enhance team performance and outcomes.
- Professional, goal-oriented, and organized Follow-Up Specialist maximizing my medical knowledge and terminology for several major hospitals and neighborhood clinics while using EPIC, MINDscape, and ORCA software.
- Displayed sound judgment when selecting the most efficient and effective method of follow-up for appealing denials and taking adjustments.
- Analyzed rejection issues while appropriately fixing errors.
- As necessary, I reviewed, corrected, and submitted claims to the appropriate payer.
- Documented a clear and concise narrative in the practice management system of the steps taken to facilitate the resolution of outstanding claims/issues.
- Ability to maintain confidentiality and handle sensitive information with solid judgment and discretion.
- Conducted timely and accurate work efficiently, with the goal of resolving outstanding claims quickly and maximizing appropriate revenue.
- Performed other duties as assigned.
Medical Billing Specialist
MTI Physical Therapy
Bellevue, Washington
06.2015 - 03.2016
- Strong, self-motivated, and a professional Medical Billing Specialist experienced in physical therapy. Billed claims using Kareo and WebPT software.
- Promptly and proficiently billed claims for seven clinics and forty-nine therapists daily using CPT and ICD-10 codes.
- Claims follow-up (rejections, no responses, and denials).
- Reviewed, resolved, and resubmitted denied or unpaid claims by appeals.
- Worked directly with insurance companies, healthcare providers, and patients to get a claim processed and paid.
- Managed and maintained 16 assigned providers' well-aged A/R.
- Customer service calls are inbound and outbound to and from patients, law offices, and insurance companies.
- Posted payments from patients, law offices, and insurance companies.
- Assigned and processed bad debt accounts to the Renton Collections Agency.
Medical Billing Specialist
Swedish Medical Center
Seattle, WA
12.2014 - 06.2015
- Highly skilled and analytical Medical Billing Specialist, who has excellent billing knowledge and experience working in a hospital. I solely billed for 6 clinics (12 doctors) daily while using EPIC, IDocLocker (IDL), and Total Sleep Resource (TSR) software.
- Billed daily for lab studies and professional fees after interpreting the doctors' reports.
- Excellent interpersonal and oral communication skills while interacting with patients and staff.
- Checked the accuracy of diagnoses and procedures by using CPT-4 and ICD-9-CM codes.
- Communicated effectively with insurance companies to ensure proper billing and payments.
- Efficiently performed and maintained month-end and end-of-quarter billing.
Medical Billing Specialist
Vitality Spine and Rehab
Kent, WA
02.2011 - 09.2014
- Dependable, detail-oriented, and knowledgeable Medical Billing Specialist. Strong patient communication skills, rapport building, and demonstrating customer-centric initiatives.
- Performed the tasks of welcoming and greeting patients, collecting co-payments, and scheduling/rescheduling appointments.
- Maintained and updated the patient's insurance and demographic information in the system.
- Contacted insurance providers to verify insurance eligibility, and sent important documents and bills to ensure payment of claims.
- Filed, organized, and scanned medical records to convert them into electronic files.
- Posted payments and billed for patient services.
- Ensured that patients had appropriate equipment, and that medical equipment needs were in compliance.
Office/Billing Manager
Rainier Beach Chiropractic
Seattle, WA
12.2005 - 01.2011
- Assisted a busy doctor's office in an organized and efficient manner with administrative tasks that included record keeping, data entry, calendar organization, patient communication, and business correspondence with accuracy and attention to detail.
- Effectively managed insurance billing and coding for all patients served.
- Communicated effectively with attorneys and insurance companies concerning claims and bills.
- Helped coordinate patient charts and had them available prior to the doctor's appointment with a patient to create efficiency within the practice.
- Managed doctors' calendar, billing, patient follow-up, and administrative tasks, including mailings and filing.
- Provided a timely, courteous, and knowledgeable response to information requests from both the doctor and the patient; screened and transferred calls.
- Kept the front office nice, professional, and organized.
Skills
- EPIC software proficiency
- Team collaboration
- Training and development
- Billing and insurance verification
- Appeals process
- Spreadsheet and report generation
- Microsoft Word and Pages
- Microsoft Excel and Numbers
- Microsoft Outlook
- Typing speed of 50 WPM with accuracy
Timeline
Insurance Follow-Up, Lead
UW Medicine
10.2022 - Current
Insurance Follow-Up Specialist
UW Medicine
03.2016 - 10.2022
Medical Billing Specialist
MTI Physical Therapy
06.2015 - 03.2016
Medical Billing Specialist
Swedish Medical Center
12.2014 - 06.2015
Medical Billing Specialist
Vitality Spine and Rehab
02.2011 - 09.2014
Office/Billing Manager
Rainier Beach Chiropractic
12.2005 - 01.2011