Dhymonique Alexander
Reidsville,NC
Summary
Experienced healthcare professional with a focus on claims management, reimbursement processes, and medical records oversight. Known for delivering exceptional client support and driving operational excellence, with a demonstrated ability to streamline workflows, ensure regulatory compliance, and maximize efficiency. Strong communicator and proactive problem-solver who excels at building relationships and meeting the unique needs of clients in the healthcare industry. Organized, meticulous, and committed to achieving results that support both client satisfaction and organizational growth.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Reimbursement Case Manager
Mercalis
05.2023 - Current
- Collaborated closely with company clients to facilitate the successful launch of a new pharmaceutical product, ensuring alignment on objectives and strategies throughout the process.
- Assisted in developing comprehensive training materials for colleagues, incorporating key product information and operational guidelines to support the effective implementation of the new pharmaceutical product.
- Provided hands-on training to colleagues, effectively conveying new material and product details from the launch to enhance team knowledge and ensure a smooth transition into the market.
- Acted as a patient advocate by guiding patients and healthcare professionals through insurance coverage, medical billing, and reimbursement processes, ensuring access to complex oncology medications through Pharmacy Prescription Triage and Medical Benefit Verification.
- Conducted insurance benefit investigations and triaged cases related to oncology medications and medical infusions in accordance with program standard operating procedures (SOPs), ensuring accurate data collection, reporting, and processing of program enrollment forms.
Medical Claims Analyst
Totalmed Staffing - UnitedHealth Group Inc.
01.2023 - 04.2023
- Analyzed and processed medical claims in compliance with insurance policies, payer guidelines, and healthcare regulations, ensuring timely and accurate claim adjudication.
- Reviewed and verified medical coding (ICD-10, CPT, HCPCS) and documentation to ensure proper claim submission, reducing errors and minimizing claim denials.
- Investigated and resolved claim discrepancies, coordinating with healthcare providers, insurance companies, and patients to facilitate claim approvals and reimbursements.
- Managed claim appeals and denials by conducting thorough analysis and submitting additional documentation to payers, successfully recovering lost revenue.
- Utilized healthcare software systems to track claim statuses, generate reports, and maintain up-to-date records, ensuring data accuracy and compliance with HIPAA standards.
Client Solutions & Operations Manager
McKesson Health
01.2022 - 01.2023
- Managed end-to-end client success operations for healthcare accounts, collaborating closely with sales teams to drive a 20% increase in client retention and cross-selling opportunities for medical products and services.
- Led cross-functional teams to manage client relationships and improve satisfaction, resulting in an increase in client retention through personalized healthcare solutions and proactive issue resolution.
- Analyzed client feedback and operational data to implement strategic improvements.
- Analyzed client feedback and sales performance data to identify upsell opportunities, driving a 10% increase in medical product sales and contributing to overall revenue growth.
- Facilitated quarterly business reviews with key stakeholders, identifying growth opportunities and ensuring alignment with client healthcare goals and company objectives.
Healthcare Access Specialist
Bswift
08.2020 - 12.2021
- Assisted patients with navigating insurance benefits and financial assistance programs, increasing access to necessary treatments and improving overall patient outcomes.
- Acted as a liaison between healthcare providers, patients, and insurers to resolve reimbursement issues, improving claim approvals and enhancing patient satisfaction.
- Conducted training sessions for healthcare providers and office staff on product handling, usage, and reimbursement protocols, ensuring optimal product utilization and compliance.
- Collected and analyzed field insights regarding market trends, reimbursement challenges, and competitor products to inform strategic planning and enhance sales effectiveness.
- Ensured all interactions and documentation adhered to regulatory standards, maintaining 100% compliance and upholding patient privacy, which resulted in zero compliance violations.
Education
Business Administration Certificate -
Central Piedmont Community College
Charlotte, NCSkills
- Salesforce CRM for healthcare client management
- Electronic Health Records Systems
- Cross-functional communication with healthcare teams and insurers
- B2B medical sales
- Health data integrity and HIPAA compliance
- Medical records auditing and documentation accuracy
- Account investigations and analysis
- Workflow optimization and process improvement
- Electronic Health Records (EHR) systems
- Claims adjudication and verification
- Claims investigation and resolution
Certification
BSN 8100 - Accounting fundamentals - Certificate of completion - Central Piedmont Community College
Timeline
Reimbursement Case Manager
Mercalis
05.2023 - Current
Medical Claims Analyst
Totalmed Staffing - UnitedHealth Group Inc.
01.2023 - 04.2023
Client Solutions & Operations Manager
McKesson Health
01.2022 - 01.2023
Healthcare Access Specialist
Bswift
08.2020 - 12.2021
Business Administration Certificate -
Central Piedmont Community College
BSN 8100 - Accounting fundamentals - Certificate of completion - Central Piedmont Community College
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