Summary
Overview
Work History
Skills
Education
Timeline
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Danielle Potts

Guyton,GA

Summary

Experienced professional with a strong background in the medical field, dedicated to supporting senior executives at Optum Incorporated. Demonstrated expertise in claims investigation and recovery, adjustments, and providing comprehensive administrative support. Proficient in various administrative tasks, technical skills, analytical thinking, data management, project management, and reporting. Committed to delivering exceptional support and making valuable contributions to organizational success.

Overview

8
8
years of professional experience

Work History

Provider Reimbursement Representative

UMR - United Health Group
09.2024 - Current
  • Review claims received in the OnBase & CPS application to determine outcome of provider claims regarding pricing/editing.
  • Manage inventory to ensure claims are repriced accurately and meet required turnaround time.
  • Perform fee schedule and contract review on assigned claims.
  • Ensure network contracts and reimbursement policies are applied accurately on affiliated medical claims.
  • Assist with UHC projects and other tasks related to provider relations.
  • Prioritize and organize own work to meet agreed upon deadlines.
  • Work with both internal and external customers to identify and resolve complex problems.
  • Review daily/weekly hold queue inventory.
  • Learned and followed all organizational policies and procedures to maintain safe and professional working environments.
  • Collected, arranged, and input information into database system.
  • Complete large dollar claims adjustments while maintaining a high level of quality.
  • Require little assistance with complex claim adjustments.
  • Adjust claims according to specified procedures and standards, meeting all position production and quality standards.
  • Apply knowledge / skills to activities that often vary from day – to – day.
  • Demonstrate a high level of knowledge and skills in own function.

Sr. Admin Assistant/BSL (Business Segment Liaison)

OptumCare
01.2021 - 09.2024
  • Provide high-level administrative support to the VP, and Senior Director of Patient and Provider Operations, and VP of Software & Engineering
  • Support includes complex calendar management, domestic and International travel arrangements, and expense reporting, Deliverables, Coordination of Executive meetings
  • Serve as a Business Segment Liaison, delivering administrative support to over 1,400 employees in Patient & Provider Operations
  • Coordinate employee onboarding, transfers, and separations, ensuring smooth transitions and compliance with organizational policies
  • Collaborate with IT to manage access permissions and troubleshoot technical and equipment issues
  • Manage a variety of projects independently and as part of a team, ensuring timely completion and adherence to quality standards
  • Create, proofread, and edit documents, spreadsheets, and presentations, maintaining high accuracy and attention to detail
  • Kept files and records in content management systems such as MS SharePoint, Excel.
  • Served as a reliable point of contact for both internal and external stakeholders, demonstrating strong problem-solving skills.
  • Facilitated successful events, including conferences and workshops, through meticulous planning, coordination, and execution of logistics.

Sr. Claims Processor/Provider Reimbursements/Project Coordinator

OptumCare
07.2018 - 01.2021
  • Investigated, recovered, and resolved various types of claims, ensuring compliance with state and federal regulations.
  • Gathered coordination of benefits data.
  • Trained claims employees on different claim types and projects.
  • Corrected team claims and gives feedback on corrections.
  • Kept updated SOP's and Job Aids for the claim's teams
  • Ensured adherence to reimbursement policies and contract compliance, conducting investigations to review medical history as necessary.
  • Strengthened relationships with external partners by consistently providing valuable assistance during investigations.
  • Improved claim processing efficiency by streamlining workflows and implementing best practices.
  • Proactively prevented potential backlog by consistently monitoring workload distribution among team members.
  • Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
  • Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.

Provider Service Advocate

OptumCare
07.2017 - 07.2018
  • Performed follow-up services for dissatisfied customers
  • Developed employee training programs to achieve an optimal level of performance during customer interactions
  • Analyzed customers' issues and complaints and initiated corrective actions
  • Greeted each customer and solved all issues and complaints via email or on phone
  • Worked effectively with fellow team members to coordinate effective solutions to any question or concern
  • Distributed supportive services information to help individuals enhance their ways of living and achieve self-sufficiency
  • Planned and implemented process improvements and reporting systems to streamline operations.
  • Supported team members, fostering a collaborative and productive work environment.
  • Improved customer satisfaction by promptly addressing inquiries and resolving issues.
  • Enhanced client retention through exceptional service delivery and proactive communication.
  • Handled escalations professionally, demonstrating composure under pressure while finding satisfactory solutions for both parties involved.

Skills

  • Visio, Excel, Word, PowerPoint, Sharepoint
  • Expertise in Office 365
  • Claims Management Systems: Proficiency in Facets, CMS, COSMOS, Macess, OnBase, CPS, and NBD
  • Project Planning
  • Professional Development
  • Claims Investigation
  • Provider Reimbursement
  • Healthcare Terminology Expertise
  • HIPAA compliance awareness
  • Contract Compliance
  • Senior Executive Assistance
  • Ariba Procurement/Concur Expense
  • Travel Coordination (Domestic & International)
  • Executive Tracking/Presentation Development
  • Business Segment Liaison Expert
  • Office Management
  • Employee Onboarding/Broadband

    • Soft Skills

  • Strategic Thinking
  • Reporting skills
  • Organizational Skills
  • High-Level Multitasking
  • Critical Decision-Making
  • Expert Time Management
  • Effective Communication
  • Adaptability, Reliability
  • Coaching Expertise

Education

true

Timeline

Provider Reimbursement Representative

UMR - United Health Group
09.2024 - Current

Sr. Admin Assistant/BSL (Business Segment Liaison)

OptumCare
01.2021 - 09.2024

Sr. Claims Processor/Provider Reimbursements/Project Coordinator

OptumCare
07.2018 - 01.2021

Provider Service Advocate

OptumCare
07.2017 - 07.2018

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Danielle Potts