Danielle Petersen
Healthcare Claims Specialist
Spokane,WA
Summary
Accomplished Medical Claims Specialist with a proven track record at Kaiser Permanente, adept in insurance claims processing and account management. Leveraged expertise in ELECTRONIC BILLING SYSTEMS and exceptional provider service skills to enhance claims accuracy and efficiency. Demonstrated ability to resolve complex billing discrepancies, achieving a high volume of accurately processed claims. Diligent Claims Specialist with solid background in medical claims processing. Proven ability to accurately handle claims and resolve complex issues while ensuring compliance with regulations. Demonstrated expertise in utilizing claims management software and maintaining detailed records. Experienced Healthcare Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 6+ years of experience and willingness to take on any challenge.
Overview
11
11
years of professional experience
Work History
Medical Claims Specialist
Kaiser Permanente
04.2021 - 03.2024
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Accurately processed large volume of medical claims every shift.
- Documented file notes clearly and concisely
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Inputted data into systems, maintaining accuracy of provider coding information and reported services.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Reviewed claims for accuracy before submitting for billing.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Processed 60-80 claims per day
AR Collection Specialist
Option Care Home Infusion
09.2018 - 12.2021
- Reviewed accounts to determine payment plan compliance.
- Met demands of busy collections group by performing high volume of daily calls.
- Remained calm, stayed professional and provided exceptional service on calls, even when interacting with difficult individuals.
- Reviewed overdue accounts to schedule contact dates for follow-up phone calls.
- Prioritized accounts based on total amount owed and credit bureau reports.
- Worked closely with delinquent account holders to collect and reconcile accounts through approved channels.
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
- Answered customer questions regarding account discrepancies or problems.
- Wrote appeal letters to insurance companies for denial of claims.
Medical Claims Processor
Pathology Laboratories Inc.
05.2014 - 08.2018
- Sent clinical request and missing information letters to obtain incomplete information.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Inputted data into systems, maintaining accuracy of provider coding information and reported services.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Reviewed claims for accuracy before submitting for billing.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Documented file notes clearly
- Checked documentation for appropriate coding, catching errors and making revisions.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
Certified Nursing Assistant
Avalon Care Center
12.2012 - 05.2013
- Distributed drinking water and nourishment to residents.
- Documented activities and recorded information in EMR system.
- Conducted routine checks on patient vitals, blood pressure, blood sugar and heart rate.
- Turned and repositioned residents using proper body mechanics to prevent pressure ulcers.
- Answered signal lights, bells or intercom systems to determine resident needs.
- Observed and reported unusual symptoms and changes to charge nurse.
- Facilitated activities of daily living, personal hygiene management, feeding and ambulation.
Education
Medical Billing And Coding
Clover Park Technical College
Lakewood, WAAssociate of Applied Science - Social Services
Spokane Falls Community College
Spokane, WA10-2011
Skills
- Account Management
- Provider service professional
- Quality-oriented team player
- Files and records management
- Accounts Payable
- Account follow-up
- Worker's Compensation Knowledge
- Insurance claims processing
- Electronic Health Record Software
- CMS-1500 Billing Forms
- Proficiency in ELECTRONIC BILLING SYSTEMS, EPIC, ICD 10, EXCEL,WORD, CMS, ETC
- Medicare Claims
Timeline
Medical Claims Specialist
Kaiser Permanente
04.2021 - 03.2024
AR Collection Specialist
Option Care Home Infusion
09.2018 - 12.2021
Medical Claims Processor
Pathology Laboratories Inc.
05.2014 - 08.2018
Certified Nursing Assistant
Avalon Care Center
12.2012 - 05.2013
Associate of Applied Science - Social Services
Spokane Falls Community College
Medical Billing And Coding
Clover Park Technical College