Deidra Kean
Mount Dora,FL
Summary
Service-oriented Claims Specialist skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes.
Business-minded with exemplary skills in customer service, time management and service coordination. Bringing over 6+ years of related experience combined with superior mathematical abilities. Pursuing similar position with expanding insurance company.
Overview
5
5
years of professional experience
Work History
Enterprise Support Coordinator
Included Health (Staffing Agency)
08.2023
- Provide real-time support to Member Support team on Enterprise related issues (270/271, Eligibility files (EOBs and COBs), Claims Status, Registration difficulties, etc.) via team chat
- Served as main point of contact for patients and team members related to inquiries or issues reported for insurance/employer eligibility
- Responsible for investigating reported outages or eligibility errors to relay to DOD Implementation team, should need arise
- Coordinate with Implementation & Engineering teams around new client launches and to resolve member and client issues
- Manage knowledge base content for Enterprise Support policies/procedures, individual client specific workflows and setups
- Execute processes and offer feedback to streamline improvements within Enterprise Support operations
- Attend operational meetings to ensure clear communication and accurate, timely handoff of information
- Work with billing partner(s) to process refunds and update member insurance information
- Maintain documentation needs as related to insurance and employer relationships on behalf of patient
- Accessed and utilized multiple EDI Clearinghouse portals (Availity/Waystar/InstaMed)
- Resolved escalated issues submitted by Member Support team as well as other internal teams
- Feedback @ and CS-ESC emails
- Salesforce - Enterprise Support
- JIRA
- Daily productivity goal of 20 or more cases maintained
- Utilized CC Admin, Salesforce customer relationship management software and Google Workspace.
Insurance Collector/Claims Management Specialist
Gastro Health (Staffing Agency)
02.2023 - 07.2023
- Worked through Claim Management edits
- Knowledge of medical terminology utilized in medical collections and billing (CPT, ICD-10, HCPCS)
- Worked through claims that are pending with errors, which will be front-end scrub edits (incorrect POS, modifiers, Provider ID, etc.)
- Verified Insurance Eligibility and Coordination of Benefits
- Reviewed multiple claim edits – CMS and Payer-Specific
- Bundling, Modifier, Medical Policy, Provider Enrollment/TIN NPI Issues, claim out-of-balance
- Experienced with navigating multiple IVR portals such as Availity and etc
- Daily productivity goal of 50 or more claims maintained
- Utilized eClinicalWorks medical billing software.
A.R Specialist/Medical Biller
Change Healthcare (Staffing Agency)
05.2022 - 11.2022
- Obtain referrals and pre-authorizations as required for procedures
- Check Eligibility and benefit verification
- Review patient bills for accuracy and completeness and obtain any missing information
- Prepare, review and transmit claims using billing software, including electronic and paper claim processing
- Follow up on unpaid claims within standard billing cycle timeframe
- Knowledge of insurance guidelines, including HMO/ PPO, Medicare and state Medicaid
- Check each insurance payment for accuracy and compliance with contract discount
- Call insurance companies regarding any discrepancy in payments if necessary
- Identify and bill secondary or tertiary insurances
- Research and appeal denied claims and resolve discrepancies
- Work with patients, set up payment plans, collection accounts and answer any questions
- Maintained daily productivity of 50 or more claims
- Utilized MDIV medical billing software.
Pharmacy Billing/Prior Authorization Specialist
Guardian Pharmacy
04.2019 - 11.2019
- Worked with facilities, families, hospice, third party insurances, and doctors to obtain and secure all needed information to properly bill without AR issues, i.e
- Prior Authorizations, Customer Agreements, Insurance and Responsible Party billing information, etc
- Rejections worked until all claims are paid to keep AR risk at a minimum while securing claims from take-back
- Maintained and worked with facilities to keep accurate and current patient census information
- Answered all billing related calls and document all pertinent information, to include but not limited to: what, why, who, where, when
- As well as adherence to use of Call Log for messages
- Maintained and monitored AR balances resolving any unpaid balances, i.e
- Working with facilities and families with positive approach resulting in positive resolution and payment
- Worked with Billing Team to effectively execute closing and production of monthly billing
- Worked collaboratively with all co-workers including all departments to assist DFA in minimizing billing issues, customer service issues, AR issues, improve efficiencies and lower costs, which all result in increase in overall profitability and customer service
- Monitored and resolved any issues with Claims Reports, High Cost, AWP/NDC reports, etc
- Performed other duties and projects as assigned
- Attendance and punctuality consistently compliant; Adhered to company policies
- Embraced constructive feedback on quality indicators, professional development, and process improvements
- Experienced with QS1 pharmacy software.
Unit Coordinator
Envision Physician Services
10.2018 - 04.2019
- Received all work in the unit on a daily basis while responsible for maintaining the accurate daily input of medical record data into the GE system in a production environment
- Kept the unit's daily production grid of received charts hourly and daily
- Handle all organization of tracking, reconciling and delivery of completed work to the scanning department
- Maintained the integrity of all work processed and the pace in which work is completed
- Communicated to the team leaders all workflow issues, unit stopping issues, special handling accounts that need the supervisors' input/resolution and any other problems/questions that may arise
- Seek immediate resolution for all discrepancies, deficient and/or red zoned charts on an hourly basis
- Ran reconciliation reports and performs daily reconciliation for each date of service/facility received
- Initials and dates original batch cover sheet, and verifies total amount sent matches cover sheet
- Verified medical records then enters records into billing system on a timely basis in order to meet and maintain the published production schedule
- Corrected errors in medical records after reviewing GEN150
- Maintained daily/weekly/monthly production deadlines and demands
- Completes all bar coding on assigned records
- Medical record reconciliation reporting
- Utilized GE Healthcare medical billing software.
Education
High School Diploma -
Deerfield Beach High
Deerfield Beach, FL06.2010
Nursing – Associate -
Palm Beach State
Boca Raton, FLSkills
- Attention to detail and analytical skills
- Exemplary customer service skills
- Online Chat
- Managing Phone Systems
- Project Facilitation
- Inventory Control Processes
- Inbound Customer Calls
- Technical Support
- Tech Assistance
- Online Databases
- Customer Relations
- Advanced with all of Microsoft Office
- Google Documents
- Calm and Professional Under Pressure
- 10-Key
- Critical Thinking
- Medical Claims
- 50 wpm typing speed
- Call Center Operations
- Quality Control
- Health Insurance Claims
- Data Evaluation
- Problem-Solving Ability
- Google Sheets
- Account Management
- Email Communication
- Pharmaceutical Claims
- Database Management
- Medical Terminology
- Data Entry
- Pharmacy
- Medical Billing
- JIRA Knowledge
- Revenue Cycle Management
- Care Coordinator
- Clinician Support
- Super-bill knowledge
- Pharmacy Coordinator
- Google Workspace Proficiency
- Document Management
- Tech-Savvy
- Project Support
Additional Information
Premier Eye Care (Staffing Agency) – Medical Admin Services Rep | Boca Raton, FL; April 2018 to August 2018
CommCare Specialty Pharmacy (Staffing Agency) - Patient Navigator | Plantation, FL; Aug 2017 to Feb 2018
Genoa Pharmacy - Registered Pharmacy Technician | Tamarac, FL; May 2016 to June 2017
RX Care Pharmacy - Fill Pharmacy Technician | Ft. Lauderdale, FL; Jan 2015 to April 2016
Lloyd Staffing – Member Services/Scheduling Specialist | Deerfield Beach, FL; Oct 2015 to Dec 2015
Walgreens - Registered Pharmacy Technician Float | Deerfield Beach, FL; Jan 2013 to Oct 2015
IRT - Inbound Sales/Customer Service Rep | Ft Lauderdale, FL; Oct 2009 to Jan 2013
License Certification
RPhT - FL Registered Pharmacy Technician - 10/2014 to 12/2024
Timeline
Enterprise Support Coordinator
Included Health (Staffing Agency)
08.2023
Insurance Collector/Claims Management Specialist
Gastro Health (Staffing Agency)
02.2023 - 07.2023
A.R Specialist/Medical Biller
Change Healthcare (Staffing Agency)
05.2022 - 11.2022
Pharmacy Billing/Prior Authorization Specialist
Guardian Pharmacy
04.2019 - 11.2019
Unit Coordinator
Envision Physician Services
10.2018 - 04.2019
High School Diploma -
Deerfield Beach High
Nursing – Associate -
Palm Beach State
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