Danielle Gore
Columbus,OH
Summary
Administrative professional with over 20 years of experience. Proven skills in managing schedules, coordinating meetings, and handling correspondence to streamline office operations. Strong proficiency in Microsoft Office Suite and excellent organizational abilities, with a track record in provider relations, bringing valuable experience in facilitating smooth interactions between providers and healthcare entities. Known for collaborative approach and results-driven mindset, consistently meeting dynamic needs of team and organization. Skilled in conflict resolution and process improvement, with focus on delivering high-quality service.
Overview
20
20
years of professional experience
Work History
Provider Relations Representative
Ohio Department of Aging
08.2025 - Current
- Facilitated communication between providers and the agency to streamline service delivery.
- Managed provider inquiries, ensuring resolution of issues within established timelines.
- Analyzed provider feedback to identify trends and recommend process improvements.
- Operates a computer or terminal to enter, update, and retrieve data from internal systems that support program operations.
- Serves as a first point of contact for program participants, providers, and internal staff, responding to inquiries by phone and email and providing accurate information or updates on case status.
- Schedules and reschedules appointments, meetings, and inspections as needed, and ensures that all correspondence and documentation is properly scanned, copied, faxed, or filed.
- Opening, sorting, and metering mail; greeting and directing visitors; maintaining logs of customer contacts and received payments; and ensuring that office supplies and equipment are stocked and operational
Administrative Professional 3/ Lead Prehearing Resolution Specialist
Ohio Department of Job and Family Services State Hearings
06.2018 - 03.2025
- Performed non-routine administrative tasks under administrative direction, making independent decisions regarding policy interpretation to resolve complex issues.
- Prepared correspondence and reports to support the Prehearing Resolution process for the Bureau of State Hearings.
- Reviewed eligibility status and benefits independently to ensure accurate determinations.
- Collaborated with counties and appellants to resolve issues related to Medical, Food Assistance, Cash, and Child Support before hearings.
- Trained new hearing assistants and prehearing resolution specialists to ensure effective onboarding and skill development.
- Hearing Assistant
- Received and reviewed hearing requests to ensure all necessary documentation was complete.
- Entered hearing request information accurately into the hearing and appeal tracking system (HATS).
- Reviewed client information using the client registry information system-enhanced (CRIS-E) to verify appeal issues.
- Verified the issues being appealed to ensure proper categorization and processing.
- Responded to inquiries regarding the status and outcome of hearings, providing clear and concise information.
- Managed the rescheduling of hearing requests to accommodate client needs and ensure timely proceedings.
- Trained new hearing assistants, providing guidance on processes and system usage.
Social Security Disability Paralegal
Barkan Meizlish Handelman Goodin DeRose Wentz. LLP
01.2016 - 06.2016
- Administered incoming client inquiries and developed effective client relationships.
- Obtained and submitted medical documentation to the Social Security Administration.
- Prepared disability documents for claimants and maintained comprehensive medical records.
- Coordinated with clients and judges to ensure compliance with deadlines.
- Managed communications through electronic media, both medical and non-medical.
- Acted as a liaison between attorneys and clients to facilitate efficient case handling.
- Prepared complete claim files for attorney hearings.
Accounts Receivable Specialist
Ohio Health
01.2015 - 12.2015
- Followed up on commercial medical claims to ensure timely processing and payment.
- Submitted medical appeals on denied claims to facilitate reconsideration and resolution.
- Demonstrated a strong understanding of UB-04, CMS-1500 forms, EOBs, and remittance advice for accurate claim handling.
- Submitted billings to appropriate parties and conducted follow-ups to ensure adjudication and payment of individual claims.
- Communicated effectively with patients, third-party payers, guarantors, family members, medical staff, and other hospital departments to manage accounts receivable.
Patient Financial Specialist/ Financial Counselor
Mt. Carmel St. Ann's
06.2010 - 01.2015
- Greeted visitors and patients, ensuring a welcoming and efficient check-in process.
- Managed patient registration, maintaining accurate and up-to-date records.
- Collected and posted patient copays, handling financial transactions with accuracy.
- Repaired and maintained spreadsheets to ensure data integrity and accessibility.
- Generated inpatient reports to support operational decision-making.
- Trained new team leads, facilitating knowledge transfer and team development.
Personal Injury Paralegal
King Law Office
01.2010 - 06.2010
- Conducted client and witness interviews to support case preparation.
- Compiled and assessed property damage estimates for case files.
- Prepared and submitted legal filings to the courthouse.
- Drafted legal memoranda, interrogatories, and personal injury demand letters.
- Negotiated personal injury settlements with insurance companies.
- Trained and mentored new paralegal interns.
Education
Associate Degree - Paralegal
Miami Jacobs Career College
Columbus, Ohio06.2010
Certificate - Medical Billing and Coding
American School of Technology
06.2005
Skills
- Microsoft Office Proficiency
- Time Management
- Organizational Skills
- Multitasking
- Office Administration
- Calendar Management
- Communication Skills
- Problem Solving
- Customer Service
- Attention to Detail
- Financial Reporting
- Clio
- Westlaw
- LexisNexis
- Claims reviewing
- Provider support
- Member enrollment
- Dispute resolution
- Provider relationship management
- Staff training and motivation
- Claims processing
- Insurance verification
- Compliance management
- Attention to detail
- Excellent communication
- Problem-solving abilities
Timeline
Provider Relations Representative
Ohio Department of Aging
08.2025 - Current
Administrative Professional 3/ Lead Prehearing Resolution Specialist
Ohio Department of Job and Family Services State Hearings
06.2018 - 03.2025
Social Security Disability Paralegal
Barkan Meizlish Handelman Goodin DeRose Wentz. LLP
01.2016 - 06.2016
Accounts Receivable Specialist
Ohio Health
01.2015 - 12.2015
Patient Financial Specialist/ Financial Counselor
Mt. Carmel St. Ann's
06.2010 - 01.2015
Personal Injury Paralegal
King Law Office
01.2010 - 06.2010
Certificate - Medical Billing and Coding
American School of Technology
Associate Degree - Paralegal
Miami Jacobs Career College