Darrionne Norvell
Management/Expert Claims Analyst/Accounts Receivable (WC, LTD, Medicare/Medicaid , Provider Solutions)
Dayton,OH
Summary
Hard-working, with exceptional experience leading teams, delivering results and exceeding expectations. Creative and motivated leader adept at utilizing exceptional design and planning strengths to accomplish complex projects. Assign tasks, train employees, provide feedback, mediate interpersonal conflicts and implement company procedures. Excellent communication and listening skills. Provide leadership and vision which drives teams to meet goals, all around team player.
Overview
13
13
years of professional experience
8
8
years of post-secondary education
Work History
Long Term Disability Claims Case Manager
Metlife
09.2023 - Current
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available. Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments
- Independently manage an assigned caseload of the most complex claims which consists of pending, ongoing/active and appeal reviews. Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations. Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination and interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during claim evaluations.
Revenue Cycle Manag/Accounts Receivable Lead
ORTHOPEDIC ASSOCIATES
05.2022 - 05.2023
- Maintain open, effective communication with clinicians, practice managers, practice executives, co- workers, patients, and outside vendors/agencies
- Review all claims for services rendered to ensure proper billing for payment of service
- Follow-up with payers to ensure timely resolution of all outstanding claims via web portals, emails, fax, or phone
- Investigate and follow up on under- and over- payments
- Completed financial reporting and analysis for billing revenue cycle.
- Viewed reports regularly to make sure processing was conducted efficiently.
- Responded to telephone and written inquiries from clients, insurance carriers, claimants, attorneys, repair shops, appraisers, physical damage experts and physicians within statutory requirements.
- Analyzed trends and data to inform decision-making and program development.
- Communicated with staff, leaders and peers to coordinate successful collaboration with other departments.
- Researched claims and incident information to deliver solutions and resolve problems.
- Examined claims forms and other records to determine insurance coverage.
- Updated aging reports based on daily audits.
- Reviewed historical records, current operational data and forecasting information to identify and capitalize on system enhancement opportunities.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Researched and resolved complex claims issues to support timely processing per state regulation
- Increased team productivity by training new hires in accounts receivable procedures and software applications.
- Developed strong relationships with clients, fostering trust and ensuring prompt payment of invoices while avoiding disputes or misunderstandings.
- Assisted management in forecasting cash inflows by providing accurate analysis of accounts receivable data and trends on a regular basis.
Administrative Office Manager
Extended Hearts Home Care
01.2017 - 05.2022
- Established workflow processes, monitored daily productivity, and implemented modifications to improve overall performance of personnel.
- Performed billing, collection, and reporting functions for office generating over $3million annually.
- Reviewed billing problems, researched issues, and resolved concerns.
- Prepared cash flow projections, cost analysis and monthly, quarterly and annual reports.
- Checked payroll, vendor payments, commissions and other accounting disbursements for accuracy and compliance.
- Reviewed historical records, current operational data and forecasting information to identify and capitalize on system enhancement opportunities.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
Resolution Expert /Provider Service Coach
CARESOURCE
10.2017 - 02.2020
- Process and resolved claim State Complaints
- Process Regulatory concerns and any related compliance issues
- Handle Provider escalations
- Mentor to new and seasoned advocates/ teams
- Excellent in providing peer to peer feedback over phone dialog.
- Motivates other advocates, peers, and employees in general
- Responsible for escalations through web or fax
- Willingness and happy to assist all times and when needed
- Role model to other advocates and employees
- Used Cactus system for credentialing updates and inputs
- Acts as subject matter expert in all lines of business(Medicaid,Medicare,Commercial)
- Coached and Managed team(5-15) on department goal/metrics
- Used daily systems(CMS, Choreo, Cactus, Facets, etc)
- Process and trained in claims processing and assignments/audits/adjudication/adjustments
- Managed side by side coaching and monthly reviews
- Maintain knowledge and understanding of all processes and procedures
- Traveled and Assisted Vendor sights with system access/projects and training
- Attention to detail; very organized
- Expert in MS Word, Spreadsheet, Excel, etc
Provider Services Specialist
CareSource
06.2016 - 10.2017
- Enhanced productivity levels by anticipating needs and delivering outstanding support.
- Updated account information to maintain provider records.
- Answered constant flow of provider calls with minimal wait times.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Handled provider inquiries and suggestions courteously and professionally.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Examined reports, accounts, and evidence to determine integrity and accuracy of information.
- Followed up with providers on unresolved issues.
- Updated claims system to track claim status and provide relevant information to other department.
Collections Team Lead Mortgage
PNC Mortgage
02.2014 - 06.2016
- Worked with underwriters to fix application problems and resolve issues.
- Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
- Fielded customer complaints and provided solutions.
- Resolved customer disputes and disagreements through professional, calm communication to find mutually beneficial solutions.
- Identified needs and provided training to clarify expectations of collections agents.
- Supervised and coordinated activities of collections employees attempting to gather monies owed from consumers.
- Generated and mailed updated statements monthly and processed demand letters.
- Documented conversations with consumers and research into accounts.
- Prepared and delivered performance reviews 8-12 collections agents to support continuous improvement of department.
- Acted as central point of contact for both employees and customers on routine credit and collection issues.
- Trained collections agents and reviewed work to reach compliance with legal requirements and company policies.
Collections Analyst II
PNC Mortgage
05.2012 - 02.2014
- Maintained high volume of calls and met demands of busy and productive group.
- Used probing techniques to determine debtors' reasons for delinquency.
- Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
- Worked in call center environment handling manual and automatically dialed outbound calls.
- Achieved performance goals on consistent basis.
- Negotiated to collect balance in full.
Education
B.A. - Business Administration
Indiana Wesleyan University
Dayton 01.2021 - Current
High school diploma -
Patterson Career Center
Dayton 08.2005 - 06.2009
Skills
Healthcare Common Procedures Coding System (HCPCS)
Negotiation and mediation skills
Team Building
Training and mentoring
Project Management
Interpersonal Communication
Teambuilding
Business Development
Proficient in Microsoft Office
Decision-Making
Problem-Solving
Investigation skills
Organizational Development
Training and Development
Affiliations
Small Group Facilitator - MTCBC
Mentorship Program
The Mert's Way Foundation Board Member
The Food Bank Inc. Volunteer
Timeline
Long Term Disability Claims Case Manager
Metlife
09.2023 - Current
Revenue Cycle Manag/Accounts Receivable Lead
ORTHOPEDIC ASSOCIATES
05.2022 - 05.2023
B.A. - Business Administration
Indiana Wesleyan University
01.2021 - Current
Resolution Expert /Provider Service Coach
CARESOURCE
10.2017 - 02.2020
Administrative Office Manager
Extended Hearts Home Care
01.2017 - 05.2022
Provider Services Specialist
CareSource
06.2016 - 10.2017
Collections Team Lead Mortgage
PNC Mortgage
02.2014 - 06.2016
Collections Analyst II
PNC Mortgage
05.2012 - 02.2014
High school diploma -
Patterson Career Center
08.2005 - 06.2009
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