Dawn Ochoa
Kankakee,IL
Summary
Dynamic and results-driven professional with extensive experience at Trinity Health, excelling in denial management and claims processing. Proven ability to reduce denial rates through meticulous claims analysis and effective communication. Strong expertise in Medicaid guidelines and a commitment to teamwork, ensuring compliance and optimizing revenue cycle performance.
Experienced denial management specialist with strong track record in healthcare claims processing and resolution. Skilled in analyzing and addressing claim denials, ensuring compliance with industry regulations, and optimizing reimbursement processes. Known for effective team collaboration, adaptability to changing needs, and results-driven approach. Proficient in utilizing medical coding systems, insurance protocols, and data analysis tools.
Experienced with denial management and claims resolution, ensuring accurate and timely claim processing. Utilizes analytical skills to identify and address root causes of denials, enhancing overall efficiency. Knowledge of industry regulations and best practices to maintain compliance and optimize revenue cycle performance.
Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Possesses versatile skills in project management, problem-solving, and collaboration. Brings fresh perspective and strong commitment to quality and success. Recognized for adaptability and proactive approach in delivering effective solutions.
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Follow up /Denial Specialist II
Trinity Health
07.2022 - Current
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Optimized workflows within the team by assigning tasks based on individual strengths and expertise in particular payers or denial reasons.
- Maintained up-to-date knowledge of industry trends and best practices in denial management, ensuring the organization''s processes remained competitive and effective.
- Streamlined communication between departments, facilitating faster resolution of denied claims.
- Identified root cause of denials to provide plans for denial resolution.
- Participated in cross-functional projects focused on improving end-to-end revenue cycle performance, leveraging expertise in denial management as a key contributor.
- Documented medical claim actions by completing forms, reports, logs and records.
- Reduced aging accounts receivable balance with timely appeal submissions for denied claims.
- Contacted clients to collect information and communicate disposition of case, documenting interactions regarding eligibility, verification of benefits and claims payment status.
- Scanned hard copy medical records and correspondence to convert into electronic files.
- Ensured compliance with industry regulations and guidelines during denial management activities, avoiding potential legal issues or penalties.
- Enhanced claims processing accuracy, rigorously verifying patient eligibility and benefit coverage.
- Reduced denial rates, implementing rigorous quality control checks before claim submission.
- Collaborated with healthcare providers to ensure accurate and timely submission of claims.
- Maintained confidentiality of patient finances, records, and health statuses.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Generated, posted and attached information to claim files.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
Medicaid Biller/collector II
Riverside Medical Center, Inc.
03.2002 - 07.2022
- Demonstrated commitment to professional development, staying abreast of industry trends and regulatory changes affecting Medicaid billing processes.
- Reduced claim denials for faster reimbursement by maintaining up-to-date knowledge of state regulations and policy changes.
- Expedited payment collection by submitting clean claims within specified timeframes to prevent delays in reimbursement.
- Coordinated with other departments to ensure seamless integration of coding, patient registration, and claim submission processes for optimal efficiency in Medicaid billing operations.
- Achieved timely reimbursements for services rendered by closely monitoring aged accounts receivables reports and taking appropriate action as needed.
- Boosted team morale and cohesiveness by fostering a positive, supportive work environment for all billing department staff members.
- Collaborated with healthcare providers to obtain necessary documentation for accurate claim submissions.
- Upheld the highest standards of integrity and ethical conduct in all Medicaid billing activities, ensuring compliance with state regulations and organizational policies.
- Ensured compliance with all HIPAA guidelines while managing sensitive patient data throughout the billing process.
- Simplified complex billing issues for colleagues by serving as a knowledgeable resource on Medicaid rules, regulations, and procedures.
- Maintained strong relationships with insurance representatives, facilitating open communication channels and prompt issue resolution.
- Improved billing accuracy by meticulously reviewing and correcting Medicaid claims before submission.
- Provided exceptional customer service when addressing inquiries from patients regarding their Medicaid coverage or billing concerns.
- Used data entry skills to accurately document and input statements.
- Collaborated with customers to resolve disputes.
- Contacted customers to discuss payment schedules and set up or immediately process payments.
- Trained new collections representatives on collections processes and incentivized team members to achieve production goals.
Education
Associate of Applied Science - Business Accountancy
Kankakee Community College
Kankakee, ILGeneral Studies
Gilman High School
Gilman, ILSkills
- Eligibility determination
- Appeals processing
- Medicaid guidelines
- ICD-10 proficiency
- HIPAA compliance
- Claims analysis
- Insurance verification
- Denial management
- Documentation review
- Provider relations
- Medical billing
- Medicare regulations
- Claim adjustment
- HCPCS knowledge
- Recordkeeping organization
- Patient rapport
- Teamwork
- Teamwork and collaboration
- Payment and investigation escalations
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking
- Claims investigation
- Multitasking Abilities
- Organizing and prioritizing work
- Reliability
- Excellent communication
- Critical thinking
- Organizational skills
- Team collaboration
- Active listening
- Effective communication
- Adaptability and flexibility
- Verbal and written communication
- Decision-making
- Teamwork skills
- Claims processing
- Relationship building
- Computer proficiency
- Documentation skills
- Team building
- Data entry
- Claims adjustment
- Task prioritization
- Self motivation
- Medical terminology
- Interpersonal skills
- Documentation
- Goal setting
- Conflict resolution
- Analytical thinking
- Professionalism
- Insurance claim forms review
- Coverage determination
- Documentation processing
- Insurance coverage verification
- Time management abilities
- Adaptability
- Denied claims identification
- Dispute resolution
Certification
CRCR
Timeline
Follow up /Denial Specialist II
Trinity Health
07.2022 - Current
Medicaid Biller/collector II
Riverside Medical Center, Inc.
03.2002 - 07.2022
Associate of Applied Science - Business Accountancy
Kankakee Community College
General Studies
Gilman High School
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