DeAndra Downing
Loganville,GA
Summary
Dedicated healthcare support professional with 20+ years of experience in customer service, medical claims processing, and patient advocacy. Proven ability to manage sensitive health information, coordinate with providers and pharmacies, and ensure compliance with healthcare regulations. Skilled in EMR systems, medical billing, and delivering compassionate service in fast-paced environments.
Overview
35
35
years of professional experience
1
1
Certification
Work History
PBM Customer Service Representative
RxSense
01.2019 - 02.2025
- Processed claims, authorizations, and accumulations with precision using Confluence and internal systems.
- Trained new staff on insurance verification procedures, enhancing team productivity and accuracy.
- Collaborated with healthcare providers to resolve discrepancies in patient insurance data.
- Updated patient records with accurate, current insurance policy information.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
HeathCare Administrative Assistant
John Knox Village Of Pompano Beach
01.2011 - 12.2019
- Developed and implemented strategic initiatives to streamline administrative processes, reducing overhead costs.
- Oversaw compliance with healthcare regulations, ensuring quality standards were consistently met across departments.
- Improved patient satisfaction by streamlining appointment scheduling and implementing electronic health records.
- Streamlined clinical documentation processes, resulting in reduced errors, increased accuracy, and improved compliance with regulatory requirements.
- Ensured compliance with industry regulations and accreditation standards through regular audits and updating internal processes accordingly.
- Achieved timely completion of projects by effectively collaborating with cross-functional teams in planning, execution, and evaluation stages.
Post Payment Analyst
St. Vincent Medical Center
02.1990 - 11.2010
- Analyzed payment transactions to ensure compliance with financial regulations and company policies.
- Developed and implemented efficient reconciliation processes to enhance accuracy of financial records.
- Collaborated with cross-functional teams to resolve discrepancies and streamline payment workflows.
- Managed complex problem-solving for upper management in order to complete projects on-time and within budget.
- Developed monthly, quarterly and annual profit and loss statements and balance sheets.
- Input financial data and produced reports using [Software].
- Demonstrated a high level of adaptability by quickly learning new software tools and technologies, incorporating them into existing processes for increased efficiency.
Education
Bachelor of Science - Health Administration
University of Phoenix
01.2026
Associate of Arts - Criminal Justice
University of Phoenix
01.2016
High School Diploma -
Ranpo Senior High School
Spring Valley, NY07-1997
Skills
- Healthcare Administration
- Medical Claims Processing
- Patient Advocacy
- EMR Systems
- Medical Billing & Coding
- HIPAA Compliance
- Customer Service
- Communication & Relationship Building
- Data analytics
Certification
- CPR & First Aid Certified
- HIPAA Awareness (if applicable)
- Customer Service Excellence (optional)
Timeline
PBM Customer Service Representative
RxSense
01.2019 - 02.2025
HeathCare Administrative Assistant
John Knox Village Of Pompano Beach
01.2011 - 12.2019
Post Payment Analyst
St. Vincent Medical Center
02.1990 - 11.2010
Associate of Arts - Criminal Justice
University of Phoenix
Bachelor of Science - Health Administration
University of Phoenix
High School Diploma -
Ranpo Senior High School
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