Diedra Hayes
Raleigh,NC
Summary
Detail-oriented healthcare professional with expertise in clinical case reviews, healthcare documentation, HIPAA compliance, OSHA regulations, and dental coding. Adept at analyzing patient records, ensuring regulatory adherence, and advocating for patient rights. A background in dental insurance claims, appeals, and grievances processes, as well as regulatory compliance and patient safety protocols. Seeking to transition into an Appeals and Grievances Clinical Specialist role to leverage my skills in documentation review, compliance analysis, and policy adherence within a healthcare organization.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Registered Dental Hygienist
Raleigh Comprehensive Cosmetic Dentistry
Raleigh, NC
03.2023 - Current
- Conducted case reviews of patient medical and dental histories, treatment plans, and insurance documentation to ensure accurate coding and compliance
- Performed thorough clinical documentation of patient exams, periodontal conditions, and treatment outcomes
- Ensured HIPAA compliance in patient records and healthcare documentation
- Educated patients on insurance coverage, treatment plans, and financial responsibilities, assisting with preauthorization inquiries
- Utilized dental coding to accurately chart procedures and update patient records
Registered Dental Hygienist & OSHA Manager
Klooster Family Dentistry
Raleigh, NC
10.2019 - 03.2023
- Reviewed patient records to verify treatment necessity and supported appeals for insurance claims related to dental procedures
- Managed OSHA compliance, ensuring adherence to workplace safety regulations and infection control protocols
- Led compliance training for staff on OSHA standards, HIPAA regulations, medical emergencies, and patient safety
- Maintained detailed patient documentation, ensuring accuracy in treatment records, case notes, and insurance submissions
- Conducted risk assessments and safety audits, identifying areas for improvement in compliance and patient care protocols
- Collaborated with providers and insurance representatives to resolve claim disputes and documentation discrepancies
Registered Dental Hygienist
Lane & Associates
Durham, NC
07.2016 - 10.2019
- Conducted clinical assessments, case reviews, and screenings for periodontal disease, oral cancers, and systemic conditions
- Documented all treatment plans, case notes, and patient interactions with strict adherence to HIPAA regulations
- Assisted patients in understanding treatment financing, insurance coverage, and appeals processes
- Maintained compliance with OSHA and infection control standards through proper sterilization procedures and safety protocols
Customer Service & Pharmacy Support
Rite Aid Pharmacy
Clayton, NC
02.2007 - 07.2012
- Assisted with insurance verification and prescription processing for patients
- Entered and updated patient data while ensuring compliance with healthcare privacy regulations
- Communicated with insurance providers and physician offices to resolve coverage and medication authorization issues
Education
Associate in Applied Science - Dental Hygiene
Wayne Community College
05.2016
High School Diploma -
Clayton High School
06.2008
Skills
- Case Review & Appeals
- Healthcare Compliance
- Dental Coding
- Insurance & Claims Processing
- Regulatory Compliance & Safety
- Electronic Health Records (EHR)
- Software Proficiency
Certification
- Registered Dental Hygienist (RDH), North Carolina
- CPR Certified
- Medical Emergencies in the Dental Setting, OSHA Compliance & Infection Control, HIPAA Compliance & Patient Privacy
Timeline
Registered Dental Hygienist
Raleigh Comprehensive Cosmetic Dentistry
03.2023 - Current
Registered Dental Hygienist & OSHA Manager
Klooster Family Dentistry
10.2019 - 03.2023
Registered Dental Hygienist
Lane & Associates
07.2016 - 10.2019
Customer Service & Pharmacy Support
Rite Aid Pharmacy
02.2007 - 07.2012
Associate in Applied Science - Dental Hygiene
Wayne Community College
High School Diploma -
Clayton High School