Daysharell Edwards
Tulsa
Summary
Customer service-oriented professional with experience meeting deadlines. Provide an understanding of clerical workflows and remain committed to ensuring optimal client outcomes. Follow policies and procedures to assure consistent quality, efficiently manage time, coordinate details, and balance competing demands. Skilled at establishing priorities, meeting deadlines, and working unsupervised. Self-motivated, ensuring all tasks are completed thoroughly and on time. Regarded as a loyal and competent employee, as evidenced by a dedicated work history.
Overview
13
13
years of professional experience
Work History
Manufacturer / Machine Operator
Bama Companies
Tulsa
09.2012 - Current
- Operate machinery in a safe and efficient manner and in accordance with company procedures.
- Continually observe product quality, rejecting sub-standard products per company protocols.
- Work within Standard Operating Procedures (SOP) and Job Safety Analysis (JSA).
- Maintain a clean work environment, efficient workspace, and proficient work processes while completing tasks as a productive team member.
- Apply knowledge of Statistical Process Control to continuously reduce variation in systems.
claims processing representive
Alliancerx Walgreens pharmacy
07.2015 - 02.2025
- Received inbound calls and set up delivery for specialty medications with patients and physician offices
- Make outbound calls to set up delivery for specialty medications with patients and physician offices.
- Test-ran medical claims using simulated patient, provider, and payer data to evaluate claim accuracy, coding compliance, and reimbursement outcomes.
- Reviewed test claims for Medicare and Medicaid to ensure proper use of ICD-10-CM, CPT, and HCPCS codes prior to submission.
- Analyzed test claim results and Explanation of Benefits (EOBs) to identify denials, underpayments, or data inconsistencies.
- Verified claim elements including demographics, modifiers, diagnosis-to-procedure linkage, and billing form requirements (CMS-1500 and UB-04).
- Documented findings from test-run claims and applied corrections to support quality assurance and claims processing accuracy.
Education
Associate of Science Degree - Medical Billing and Coding
Ultimate Medical Academy
Tampa, FL01.2024
HIPAA Essentials for Healthcare Professionals Certificate -
Ultimate Medical Academy
Tampa, FLSkills
- Medical Billing
- Accounts Receivable
- Collections
- Co-Pay
- Deductibles
- Co-Insurance
- EOBs
- Revenue Cycle Management
- Posting Payments
- Government (Medicare & Medicaid)
- Third Party Payers
- Electronic Health Records (EHR)
- Electronic Medical Records (EMR)
- Managed Care (HMO, PPO, POS)
- Workers Compensation
- Insurance Verification
- Insurance Claim Processing
- CMS 1500
- CMS 1450 (UB-04)
- Front Office Operations
- Medical Office Procedures
- Scheduling
- Medical Terminology
- Anatomy & Physiology
- HIPAA Compliance
- Medical Coding (ICD-10-CM, HCPCS, CPT)
Timeline
claims processing representive
Alliancerx Walgreens pharmacy
07.2015 - 02.2025
Manufacturer / Machine Operator
Bama Companies
09.2012 - Current
Associate of Science Degree - Medical Billing and Coding
Ultimate Medical Academy
HIPAA Essentials for Healthcare Professionals Certificate -
Ultimate Medical Academy