Denise Turner
Fairburn,US
Summary
Experienced Healthcare Supervisor with 25+ years leading call center operations and medical coding teams. Excels in customer service and team leadership. Skilled in budget management, staff training, and quality assurance, consistently improving efficiency and ensuring satisfaction. Committed to fostering collaboration, optimizing workflows, and driving results through innovative solutions. Proven track record in managing claims operations and improving efficiency as a medical claims professional. Adept at fostering team collaboration and achieving high-quality results in dynamic environments. Recognized for strong analytical skills and ability to adapt to changing needs while maintaining accuracy and compliance. Knowledgeable with a solid background in overseeing medical claims processes and ensuring compliance with industry regulations. Successfully managed teams to streamline workflows and reduce processing times. Demonstrated expertise in problem-solving and effective communication to resolve complex claims issues.
Medical claims professional with proven track record in managing claims operations and improving efficiency. Adept at fostering team collaboration and achieving high-quality results in dynamic environments. Recognized for strong analytical skills and ability to adapt to changing needs while maintaining focus on accuracy and compliance.
Knowledgeable with solid background in overseeing medical claims processes and ensuring compliance with industry regulations. Successfully managed teams to streamline workflows and reduce processing times. Demonstrated expertise in problem-solving and effective communication to resolve complex claims issues.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Medical Claims Supervisor
TSC
01.2000 - 02.2025
- Negotiated favorable settlement terms with healthcare providers, reducing financial liabilities for the organization.
- Contributed to the creation of a positive work environment through open communication and proactive problem-solving initiatives.
- Championed continuous improvement initiatives within the department, leading efforts aimed at operational excellence.
- Implemented strict quality control measures for medical claim submissions, resulting in fewer denials and provides operational management and oversight of integrated Healthcare Services (HCS) teams and assisting them to achieve optimal clinical, financial, and quality of life outcomes.
- Responsible for clinical teams (including operational teams, where integrated) performing one or more of the following activities: care review/utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), case management, transition of care, health management and/or member assessment.
- Typically, through one or more direct report supervisors, facilitates integrated, proactive HCS management, ensuring compliance with state and federal regulatory and accrediting standards.
- Manages and evaluates team member performance; provides coaching, counseling, employee development, and recognition; ensures ongoing, appropriate staff training; and has responsibility for the selection, orientation and mentoring of new staff.
- Performs and promotes interdepartmental/ multidisciplinary integration and collaboration to enhance the continuity of care including Behavioral Health and Long-Term Services & Supports for Molina members. Oversees Interdisciplinary Care Team meetings.
- Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities.
- Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
- Collates and reports on Care Access and Monitoring statistics including plan utilization, staff productivity, cost effective utilization of services, management of targeted member population, and triage activities.
- Ensures completion of staff quality audit reviews. Evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines.
- Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement.
Senior Healthcare Recruiter
Centecorp
03.2015 - 02.2024
- Successfully recruited for a diverse range of healthcare roles, including but not limited to physicians, nurses, allied health professionals, and administrative staff.
- Utilized advanced search techniques on various platforms to identify potential candidates for hard-to-fill healthcare roles.
- Enhanced client satisfaction by consistently meeting and exceeding recruitment targets for top-tier healthcare organizations.
- Led training sessions for junior recruiters, enhancing their knowledge of best practices in healthcare recruitment strategies.Lead the full recruiting process for physicians and advanced practitioners, including prospecting, qualifying, interviewing, and matching candidates to client opportunities.
- Build and maintain strong relationships with both clients and providers to drive business growth and ensure successful placements, from recruitment through assignment completion.
- Provide regular updates to clients on recruitment progress and candidate pipelines, maintaining clear communication throughout the process.
- Manage and track provider information, availability, and data in the CRM, ensuring accuracy and up-to-date records.
- Utilize various sourcing platforms to build and maintain a strong pipeline of qualified candidates for current and future opportunities.
- Meet or exceed performance goals (KPIs) by managing daily activities, such as calls, follow-ups, and meetings, while delivering exceptional customer service to both internal and external stakeholders.
- Resolve provider concerns and feedback to continuously improve services, while adhering to policies, procedures, and legal regulations.
- Attend conferences, client site visits, and participate in special projects as required, consistently upholding Jackson and Coker's core values of Others First, Growth, and Wisdom.
HR Coordinator
TSC
04.1996 - 01.2000
- Maintained human resources information system and kept employee files up to date and accurate.
- Completed background and reference checks to facilitate hiring and onboarding of employees.
- Assisted in payroll processing, ensuring accurate compensation for all employees based on hours worked and applicable deductions.
- Assisted with recruitment process by posting job ads, filtering applications, scheduling interviews, assisting in interview process and drafting offer letters.
Education
MBA -
Charter University
LOS ANGELES, CAMedical Coding Certificate -
Skills
- Customer Service
- Issue Resolution
- Call Center Management
- Employee Scheduling
- Call Monitoring
- Performance Evaluations
- CRM
- Call Center Operations
- Team Leadership
- Budget Management
- Quality Assurance
- Staff Training
- Claims management expertise
- Strong decision-making
- Claims processing efficiency
- Team leadership
Personal Information
Title: Healthcare Supervisor
Certification
- Privacy and Security Certification – HIMSS.
- HIPAA Compliance Officer Certification – Supremus Group LLC.
- ICD-10-CM/PCS Trainer Certificate– American Health Information Management Association(AHIMA).
- Compliance Officer Certificate Program–Health Care Compliance Association(HCCA).
- Salesforce Certified Administrator
Timeline
Senior Healthcare Recruiter
Centecorp
03.2015 - 02.2024
Medical Claims Supervisor
TSC
01.2000 - 02.2025
HR Coordinator
TSC
04.1996 - 01.2000
Medical Coding Certificate -
MBA -
Charter University
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