Deborah Harrell
Apollo Beach,Florida
Summary
Outgoing Claims Quality Assurance Manager with over 5 years of managerial experience in the Healthcare Industry. Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
10
10
years of professional experience
Work History
CLAIMS QUALITY ASSURANCE MANAGER
Valuehealth Benefit Administrators
09.2022 - Current
- Conducted regular audits to ensure adherence to established protocols, maintaining consistency across the organization.
- Trained team members on quality assurance principles, fostering a culture of accountability and high performance.
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
TEAM LEADER/CLAIMS PROCESSOR II
Leading Edge Administrators
04.2021 - 09.2022
- Set performance expectations for the team, monitoring progress towards goals and providing constructive feedback as needed.
- Empowered team members by delegating responsibilities according to individual strengths and areas of expertise.
- Managed conflict resolution among team members, fostering a positive and collaborative work environment.
- Developed team members'' skills through targeted coaching sessions, resulting in improved individual performance.
MEDICAL CLAIMS ADJUSTER
The Loomis Company
12.2020 - 04.2021
- Analyzed policy details along with supporting documents provided by healthcare providers to make informed decisions on claims approvals or denials.
- Resolved complex claims issues for expedited processing and resolution.
- Maintained strict compliance with HIPAA regulations, safeguarding patient privacy throughout the claim evaluation process.
BENEFITS ADJUSTER II
American Public Life
05.2018 - 06.2020
- Maintained strong relationships with policyholders, agents, and colleagues by consistently demonstrating professionalism, empathy, and effective communication skills.
- Ensured compliance with state regulations and company policies through diligent review of all claim-related materials.
- Increased overall productivity by managing a large caseload while maintaining strict attention to detail and accuracy in documentation.
SENIOR MEDICAL CLAIMS EXAMINER/ADJUSTER/SME
Synergy Services DBA Talentwave
05.2016 - 05.2018
- Expertly navigated disputes between parties involved in the claiming process, leading to fair resolutions.
- Served as a subject matter expert in company audits, providing insights into effective medical claims examination practices.
- Streamlined workflow for faster claims resolution, resulting in increased customer satisfaction.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
REVENUE SPECIALIST II
Florida Medical Clinic
03.2014 - 05.2016
- Increased revenue by streamlining billing processes and implementing effective collection strategies.
- Reduced outstanding debts by implementing a proactive collections process and establishing strong relationships with clients.
- Managed accounts receivable, ensuring timely invoicing and accurate record-keeping for improved cash flow.
- Stayed up-to-date on industry best practices and emerging technologies, applying new knowledge to drive revenue growth and operational excellence.
Education
Associate Degree in Christian Theology -
Life Christian University
Tampa, Florida01.2014
High School Diploma -
J.P. McCaskey High School
Lancaster, PA06.1990
Skills
- Medical claims processing/billing
- Medical terminology
- Insurance verification
- Medicare/Medicaid/Commercial insurances
- CMS 1500/UB-04 claims
- CPT/HCPCS coding
- QA Claims auditing
- Claims/Audit training
- Policy processes and procedures
- Appeals/grievances
- Attention to Detail
- Critical Thinking
Timeline
CLAIMS QUALITY ASSURANCE MANAGER
Valuehealth Benefit Administrators
09.2022 - Current
TEAM LEADER/CLAIMS PROCESSOR II
Leading Edge Administrators
04.2021 - 09.2022
MEDICAL CLAIMS ADJUSTER
The Loomis Company
12.2020 - 04.2021
BENEFITS ADJUSTER II
American Public Life
05.2018 - 06.2020
SENIOR MEDICAL CLAIMS EXAMINER/ADJUSTER/SME
Synergy Services DBA Talentwave
05.2016 - 05.2018
REVENUE SPECIALIST II
Florida Medical Clinic
03.2014 - 05.2016
Associate Degree in Christian Theology -
Life Christian University
High School Diploma -
J.P. McCaskey High School
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