Danielle L. Byrd
Converse
Summary
Seasoned Arbitration Manager known for high productivity and efficient completion of tasks. Possess specialized skills in conflict resolution, negotiation techniques, and legal compliance. Excel in communication, leadership, and problem-solving, ensuring successful arbitration outcomes. Thrive in fast-paced environments, making sound decisions under pressure.
Overview
15
15
years of professional experience
Work History
Mediation Arbitration
CENTENE CORPORTION
Converse
10.2024 - 07.2025
- Evaluate of grievance and appeal claims.
- Work excel spreadsheet.
- Complete and review arbitration letters.
- Complete payment into TDI.
- Review patient information in Amysis system.
- Review and update Initial Case.
CSR/Insurance Verification
3M/KCI
08.2021 - 10.2024
- Assists Clients and Customers, via telephone, e-mail or chat, with orders, inquiries, requests, problem resolution, and comments/feedback regarding products/services and verification.
- Consults with Clients and Customers to identify additional needs related to the products or services.
- Insure Correct billing ICD10 are applied.
- Recommends appropriate products, services, or solutions.
- Works on assigned client programs.
- Performs duties in a courteous, efficient, and professional manner.
- Work directly with Government and Commercial Insurance verification of coverage and benefits to include processing of all medical devices and supply orders.
- Assisted customers with inquiries and product information effectively.
- Managed order processing and inventory updates in the system.
- Collaborated with teams to address customer complaints promptly.
- Trained new staff on customer service protocols and company policies.
Provider Dispute Analyst
Bright Healthcare
07.2021 - 08.2023
- Efficiently reviewed and researched dispute cases, resulting in accurate claims reprocessing, and adeptly created and maintained appeal response templates.
- Functioned as a valuable departmental resource for appeal-related concerns and consistently maintained a robust grasp of fundamental medical terminology to enhance comprehension of services and procedures.
- Leveraged effective problem-solving skills to drive dispute resolutions, fostering mutual understanding of opposing viewpoints.
- Thoroughly validated and ensured the accuracy of documentation on updated systems.
- Consistently adhered to departmental processes, procedures, and goal expectations for conducting case investigations.
- Investigated, researched, and promptly resolved payment claims within stipulated timeframes.
- Maintained current industry knowledge, and tracked system updates, network regulations, and compliance matters.
- Demonstrated sound judgment and utilized available resources to make informed decisions for case approval or denial.
- Analyzed and resolved complex healthcare disputes efficiently.
- Collaborated with cross-functional teams to address client concerns.
- Reviewed documentation for compliance with regulatory standards.
Office Manager/Medical Billing
Patient Solutions
01.2021 - 07.2021
- Assists Clients and Customers, via telephone, email or chat, with orders for DME, inquiries, requests, problem resolution, and comments/feedback regarding DME equipment (CPAP/APAP devices, wheelchairs, and supplies).
- Medical Billing Department AR reporting, posting and balance patient account, billing medical insurance and private pay.
- Conduct daily office task of order supplies, inventory, and maintain office employment.
- Managed daily office operations and coordinated administrative functions.
- Oversaw appointment scheduling for patients and staff meetings.
- Maintained office supplies inventory and ordered necessary materials.
- Implemented efficient filing systems to enhance document organization.
- Assisted in onboarding new employees and training office staff.
- Facilitated communication between departments to ensure workflow efficiency.
- Developed office policies to improve operational effectiveness and compliance.
- Coordinated patient billing processes and handled inquiries effectively.
- Maintained filing system for records, correspondence and other documents.
- Answered phone calls, responded to emails, routed mail and coordinated courier services.
- Managed office inventory and placed new supply orders.
- Managed front desk operations including greeting visitors, answering questions or directing them to appropriate personnel.
- Resolved customer inquiries in a timely manner while maintaining positive relationships with clients.
Supply Manager/Insurance Verification
Medtronic
07.2014 - 01.2021
- Company Overview: San Antonio Tx.
- Assists Supply Clients and Customers, via telephone, e-mail or chat, with orders, inquiries, requests, problem resolution, and comments/feedback regarding products/services and verification.
- Consults with Clients and Customers to identify additional needs related to the products or services.
- Recommends appropriate products, services, or solutions.
- Works on assigned client programs.
- Performs duties in a courteous, efficient, and professional manner.
- Work directly with Government and Commercial Insurance verification of coverage and benefits to include processing of all medical devices and supply orders.
- San Antonio Tx.
- Managed supply chain operations for medical device distribution.
- Coordinated inventory levels with production schedules to ensure availability.
- Developed supplier relationships to enhance procurement processes.
- Implemented cost-saving initiatives within supply management practices.
- Analyzed market trends to inform sourcing strategies and decisions.
- Trained and mentored junior staff on supply chain protocols.
- Analyzed existing supply chains to identify areas for improvement in efficiency, accuracy and cost savings.
Enrollment Processor, Provider Data Analyst, Grievance & Appeals Coordinator
United Healthcare
03.2013 - 06.2014
- Company Overview: San Antonio, Tx
- Handled special projects from outbound calls to internal paperwork needing to be entered into the system.
- Received tasks from other departments to handle, was given Helpdesk role for CIP after 4 months of employment.
- Managed about 10-15 people and provided training and individual coaching sessions for all associates.
- Maintained detailed and accurate records between multiple databases and programs.
- Checked documentation for accuracy and validity on updated systems.
- Maintained confidentiality of patient eligibility, records, and heath statuses.
- Verified client information by analyzing existing evidence on file.
- Handled escalated issues for member by making outbound calls to provider and other entities.
- Assisted members with claims questions regarding diagnosis codes, copayment, appeals, fraud claims and reimbursement requests.
- Created and maintained multiple databases, including, contract provider network, prior authorization, third party liability, provider set ups and related corrections.
- Scheduled monthly provider verifications regarding provider enrollment specifications and demographic changes.
- Updated delegated provider Medicare and Medicaid documents on a monthly and ad hoc basis and ensure state compliance.
- Reviewed appeals, complaints and claims from providers, determined validity and help build satisfactory resolutions.
- Managed time efficiently in order to complete all tasks with deadlines.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
- Conducted full claim and appeal investigations and reported updates and resolutions.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, appeal procedures, and HIPAA regulations.
- San Antonio, Tx
- Monitored incoming applications for compliance with governmental regulations.
- Provided detailed reports on enrollment trends to management team.
- Developed training materials for new staff members on enrollment processes.
- Maintained up-to-date knowledge of relevant regulations and policies.
Billing Specialist
South Texas for Pediatric Care
10.2010 - 02.2013
- Obtain new sales information from managers and prepare invoices to be sent to patient/customers.
- Interact with patients via phone and email regarding unpaid balances and discuss options for payment.
- Set up payment plans for customers upon request and provide updated information to accounting manager.
- Cross-check information entered into bookkeeping software to ensure accuracy and report any discrepancies to manager.
- Trained incoming staff members on office billing practices and procedures.
- Processed patient billing and insurance claims efficiently.
- Reviewed and corrected billing discrepancies for accuracy.
- Collaborated with healthcare providers to verify service codes and charges.
- Monitored account receivables to ensure timely collections from insurance companies.
- Answered customer inquiries regarding billings, payments, account status.
Education
Masters Degree - Business Administration and Human Resources
Wayland Baptist University
San Antonio, TX 12.2018 - 06/2019
Bachelors Degree - Business Administration and Medical Management
Wayland Baptist University
San Antonio, TX 08.2015 - 08/2017
Associate Degree - Business Administration and Medical Practice Management
Kaplan College
San Antonio, TXDiploma -
Judson High School
Converse, TXSkills
- Claims Processing
- Resource Management
- Services & Procedures
- End-To-End Recruitment Operations
- Candidate Sourcing & Selection
- Training & Development
- Team Building & Management
- Advanced computer skills in Access
- Advanced computer skills in PowerPoint
- Advanced computer skills in Word
- Learns new software applications quickly
- Keyboard/Type 50wpm
- Grievance evaluation
- Arbitration letter drafting
- Claims processing
- Medical terminology
Additional Information
Additional References are Available Upon Request
Education Experience
- Wayland Baptist University, San Antonio, TX, Masters Degree in Business Administration and Human Resources, 02/2018, 06/2019
- Wayland Baptist University, San Antonio, TX, Bachelors Degree in Business Administration and Medical Management, 08/2016, 08/2017
- Kaplan College, San Antonio, TX, Associate Degree in Business Administration and Medical Practice Management, 10/2009, 02/2011
- Judson High School, Converse, TX, Diploma, 01/1991, 01/1991
Timeline
Mediation Arbitration
CENTENE CORPORTION
10.2024 - 07.2025
CSR/Insurance Verification
3M/KCI
08.2021 - 10.2024
Provider Dispute Analyst
Bright Healthcare
07.2021 - 08.2023
Office Manager/Medical Billing
Patient Solutions
01.2021 - 07.2021
Masters Degree - Business Administration and Human Resources
Wayland Baptist University
12.2018 - 06/2019
Bachelors Degree - Business Administration and Medical Management
Wayland Baptist University
08.2015 - 08/2017
Supply Manager/Insurance Verification
Medtronic
07.2014 - 01.2021
Enrollment Processor, Provider Data Analyst, Grievance & Appeals Coordinator
United Healthcare
03.2013 - 06.2014
Billing Specialist
South Texas for Pediatric Care
10.2010 - 02.2013
Associate Degree - Business Administration and Medical Practice Management
Kaplan College
Diploma -
Judson High School