Deveona Lepierro
Fairfield
Summary
Skilled claims processing professional with extensive experience in reviewing and validating insurance claims. Strong focus on accuracy, problem-solving, and effective communication. Known for collaborative approach and adaptability to changing needs. Proficient in claims software, data entry, and customer service. Recognized for reliability and achieving results in team environments. Experienced with processing diverse insurance claims and ensuring compliance with regulatory standards. Utilizes attention to detail and analytical skills to identify discrepancies and expedite resolutions. Track record of maintaining accurate records and delivering exceptional customer service.
Overview
9
9
years of professional experience
Work History
Claims Processer 1
Zenith American Solutions
03.2024 - Current
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing meet deadlines.
- Followed up with customers on unresolved issues.
- Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
Claims Analyst
Centene
08.2022 - 02.2024
- Claims Processing: Accurately review, analyze, and adjudicate dental insurance claims in compliance with policy guidelines, contractual agreements, and state regulations.
- Data Verification: Verify patient information, treatment plans, and coding accuracy (e.g., CDT codes) to ensure proper claims processing.
- Decision Making: Approve or deny claims based on dental policies, medical necessity, and documentation provided by dentists or patients.
- Communication: Collaborate with dental providers, patients, and insurance teams to resolve claim inquiries, discrepancies, and appeals.
- Documentation: Maintain detailed records of processed claims and ensure compliance with HIPAA and company confidentiality policies.
- Problem Solving: Investigate complex claims issues, identify errors or fraudulent activities, and recommend corrective actions.
- Knowledge Management: Stay up-to-date with industry standards, insurance policy updates, and dental terminology to improve claim review accuracy.
- Quality Assurance: Ensure high levels of accuracy and efficiency while meeting performance targets and deadlines.
- Customer Service: Provide professional and courteous support to stakeholders regarding claim statuses, benefits, and payment explanations.
Member Service Rep II
United HealthGroup
04.2018 - 07.2022
- Maintain high standards of customer service during high volume, fast-paced operations
- Handle financial transactions quickly and accurately via EPIC payment posting
- Verified insurance eligibility, payments and deductibles
- Build positive relationships with customers through approachable and friendly interactions
- Take initiative to find extra tasks when scheduled duties were completed
- Adhere to company quality assurance guidelines
Cashier/Salesperson
Big 5 Sportings Good
10.2017 - 01.2018
- Manage the cash register in order to check out customers in a timely fashion
- Provide information on store products to customers, always focusing on politeness and interpersonal relationships
- Answer and return customer phone calls, providing sufficient answers to questions
- Conduct communication regarding product sales to customers
- Opening and closing of store on designated days
- Training of newly hired employees
- Assisted with inventory control
Courtesy Clerk
Safeway
05.2016 - 06.2017
- Collect shopping carts from the parking lot and transport them to the front of the story
- Sign and date rain checks
- Bag groceries
- Clean and straighten designated store areas on a regular basis
Education
Associate's Degree - Medical Billing And Coding
Carrington College California
Sacramento, CA12-2025
High school diploma or GED -
John Adams Campus, City College of San Francisco
San Francisco, CA08.2018
Skills
- Medical terminology
- Explanation of Benefits (EOB)
- Remittance Advice (RA)
- ICD-10
- CPT
- Claim investigation
- Claims review
- Research
- Microsoft Word
- Medical documentation
- Microsoft Office
- Documentation review
- Microsoft Excel
- Data entry
- Time management
- Microsoft Outlook
- Microsoft Power point
- Medical billing
- Dispute tracking
- Proficient in EPIC
- Accuracy and precision
- Transactions reconciliation
- Claims
- Payments posting
- Attention to detail
- Claims processing
- Billing software
- Customer service
- Claims adjustment
- Claim amount calculations
- Microsoft office
- Insurance claim forms review
- Coverage determination
- Documentation skills
Education and Training
true
Timeline
Claims Processer 1
Zenith American Solutions
03.2024 - Current
Claims Analyst
Centene
08.2022 - 02.2024
Member Service Rep II
United HealthGroup
04.2018 - 07.2022
Cashier/Salesperson
Big 5 Sportings Good
10.2017 - 01.2018
Courtesy Clerk
Safeway
05.2016 - 06.2017
High school diploma or GED -
John Adams Campus, City College of San Francisco
Associate's Degree - Medical Billing And Coding
Carrington College California
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