Debra Holmes
Miami,Florida
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
30
30
years of professional experience
Work History
Claims Processor
Catalyst Solutions
04.2024 - Current
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing meet deadlines.
- Evaluated accuracy and quality of data entered into agency management system.
Provider Enrollment Specialist
NTT Data
10.2024 - 04.2024
- Provided guidance to providers on the enrollment process, timelines, and requirements.
- Reviewed and updated provider enrollment applications to ensure accuracy and completeness of information.
- Created detailed reports outlining updates made to provider profiles as well as any issues or errors encountered during processing activities.
- Maintained provider enrollments in Medicare and Medicaid across states.
- Completed day-to-day duties accurately and efficiently.
- Processed re-enrollment requests for terminated providers who wish to be reinstated into the network.
- Handled new enrollments by entering customers' data and reviewing information.
- Responded promptly to inquiries from providers regarding their status within the network.
Sr Claims Readjudication Specialist
AvMed Health Plans
07.1994 - 02.2023
- Conducted day-to-day administrative tasks to maintain information files and process paperwork
- Examined claims forms and other records to determine insurance coverage
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues
- Researched claims and incident information to deliver solutions and resolve problems
- Process new day claims and review claims that was submitted by providers disputing any issues with their claims
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
Education
High school diploma - Office professional
Ft Myers Senior High School
06.1978
Skills
- Detailed Oriented
- Well experience in the claims department
- Skilled in written and oral communications
- Have experience in auditing claims
- Works in excel and other spreadsheets
- Healthcare Knowledge
- Physician Enrollment
- Special Projects
- Data Entry Skills
- Claims Processing
- Claim Amount Calculations
Timeline
Provider Enrollment Specialist
NTT Data
10.2024 - 04.2024
Claims Processor
Catalyst Solutions
04.2024 - Current
Sr Claims Readjudication Specialist
AvMed Health Plans
07.1994 - 02.2023
High school diploma - Office professional
Ft Myers Senior High School