DEANNA LOVE
Summary
Computer security professional with years of progressive experience in healthcare compliance industry. Demonstrated skill identifying business risks and compliance issues and designing proactive solutions. Background designing and implementing layered network security approaches.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Fraud Investigator/Arbitration Claims Analyst
BANK OF AMERICA
02.2023 - Current
- Reviewed reports and individual transactions which appeared suspicious to uncover possible fraudulent activity.
- Performed risk assessments to determine level of fraud risk and prioritize investigations.
- Produced detailed reports of fraud investigations and presented findings to senior management.
- Evaluated success of fraud detection systems to identify areas for improvement.
- Conduct prompt and thorough investigations on referred files.
- Analyzed large amounts of data to find patterns of fraud and anomalies.
- Manage caseload of up to 80 claims per month
- Developed and implemented procedures to detect and prevent fraud.
Radiology Imaging Coordinator
EMORY HEALTHCARE
04.2014 - Current
- Manage day-to-day operations, logistics and schedules.
- Implement successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
- Obtain physician referrals for patients and sign off on verbal orders when physical orders unattainable
- Modify existing info, update, and generate monthly patient visit reports for all radiologic modalities as well as the Emergency Department
- Lead morning huddle meetings for techs and physicians to bring awareness to changes in patient flow, any observed errors, and any departmental issues that need to be addressed
- Prepare medical records for release to patients, physicians, and attorney offices
- Reconcile duplicate patient accounts in EMR system and update records to reflect most accurate
- Transcribe patient diagnostic information into radiology and hospital information systems.
- Train, manage and motivate team of eight radiology personnel performing over 10k imaging studies each year.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
- Liaise with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
- Spearheaded and implemented new projects to expand scope of engagement.
Quality Assurance Operations Supervisor
OFFICE OF TEMPORARY DISABILITY ASSISTANCE (ERAP)
03.2022 - 09.2022
- Monitor specialists calls within the contact center using call recording applications and rate calls based on company standards
- Implement coaching and provide suggestions for call quality and improvement to ensure targeted metrics are reached
- Lead daily team meetings to discuss metrics and directives for the day
- Attend daily leadership meetings to update project management on the status of team progress
- Collaborate with WFM to establish contact center needs i.e
- (staffing needs, volume predictions, and other business necessities)
- Manage/monitor scheduling, attendance and other needs of specialists using various platforms (Deltek, Oracle, Verint)
- Process and review applications submitted by applicants for federal funding using alphanumeric data entry
- Motivated and trained employees to maximize team productivity.
- QC over 100 applications daily from specialists to ensure accuracy and error free.
- Evaluated team member performance and productivity, provided feedback and implemented corrective actions.
- Enforced regulatory and company policy compliance to improve workplace and employee safety and readiness.
Claims Associate/Insurance Verifier
ATLANTA HEART SPECIALISTS
05.2012 - 01.2014
- Verify patient insurance by contacting insurance companies via phone and/or web portals
- Input patient visit charges into EMR system and collect co-pays
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Document all claim activity including correspondence, payments, and settlements in order to resolve new or outstanding claims
- Contact affiliate hospitals and/or insurance company to obtain prior authorization for patients prior to appointment.
- Generated, posted and attached information to claim files.
- Analyzed and addressed escalated claims to resolve issues quickly
- Worked productively in fast-moving work environment to process large volumes of claims.
- Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
Education
BBA - Biology
GEORGIA SOUTHERN UNIVERSITY
Statesboro, GASkills
- Records Research
- Financial Fraud
- Trained in EPIC, GE Ris, Genesys, EMR systems
- Information Governance
- Proficient in Microsoft Office, G suite, Excel, Zendesk,HIPPA compliance
- Trend Analysis
- Activity Monitoring
- Verbal and Written Communication
- Operations Management
- Policy Implementation
- Key Performance Indicators
- Customer Relationship Management (CRM)
Certification
- IBM Cybersecurity Analyst Training - September 2023-present
- CompTiA security + certification - September 2023 - present
- HIPPA Training - annually 2014 to present
Timeline
Fraud Investigator/Arbitration Claims Analyst
BANK OF AMERICA
02.2023 - Current
Quality Assurance Operations Supervisor
OFFICE OF TEMPORARY DISABILITY ASSISTANCE (ERAP)
03.2022 - 09.2022
Radiology Imaging Coordinator
EMORY HEALTHCARE
04.2014 - Current
Claims Associate/Insurance Verifier
ATLANTA HEART SPECIALISTS
05.2012 - 01.2014
BBA - Biology
GEORGIA SOUTHERN UNIVERSITY