Dneka Buck
Olivehurst,CA
Summary
Accomplished Test Claim Specialist with a proven track record at Coram, adept in handling sensitive information and enhancing customer satisfaction. Excelled in reducing claim processing times through efficient workflow strategies. Skilled in Microsoft Office and proficient in ICD 9 and ICD 10 coding, demonstrating exceptional analytical abilities and a commitment to excellence.
Overview
14
14
years of professional experience
Work History
Test Claim Specialist/Prior Authorization Specialist
Coram
03.2017 - Current
- Reviewed and maintained accurate claim files, ensuring all necessary documentation was in place for future reference.
- Maintained compliance with industry regulations by staying up-to-date on changes in policies and procedures, ensuring proper handling of sensitive information.
- Conducted thorough investigations into insurance claims to determine coverage eligibility and appropriate compensation amounts.
- Enhanced customer satisfaction with prompt and accurate claim resolutions, resulting in positive feedback and increased client retention.
- Provided exceptional customer service during difficult situations, displaying empathy while explaining complex claim issues clearly to clients.
- Managed high-volume caseloads effectively, prioritizing urgent cases while maintaining attention to detail for all claims.
Claims Examiner
Health Net Federal Services LLC
09.2015 - 09.2017
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
Intake Representative
Health Net Federal Services LLC
03.2014 - 04.2015
- Exceeded performance metrics regularly, demonstrating consistent dedication to quality work and customer satisfaction.
- Reduced wait times for clients by promptly addressing inquiries and providing clear, concise information regarding services.
- Provided accurate insurance verification for clients, ensuring proper coverage was in place prior to service delivery.
- Assisted in the development of training materials for new Intake Representatives, contributing to overall team success.
Sales Associate
Marshalls Department Store
09.2010 - 03.2014
- Organized racks and shelves to maintain store visual appeal, engage customers, and promote specific merchandise.
- Handled cash transactions efficiently while adhering to company cash handling policies, ensuring accuracy in all financial exchanges.
- Built relationships with customers to encourage repeat business.
- Managed returns, exchanges and refunds in accordance with store policy.
Education
Associate of Science - Medical Office Administration
Heald College
Roseville, CA01.2014
High School Diploma -
East Nicolaus High School
Nicolaus, CA06.2008
Skills
Microsoft Office: Word, Excel, and Power Point
Programs: Citrix Receiver, Salesforce, HCN 360, and EPIC
Microsoft Office Outlook
Microsoft Office Teams
Type: 40 WPM
ICD 9, ICD 10, CPT codes
Timeline
Test Claim Specialist/Prior Authorization Specialist
Coram
03.2017 - Current
Claims Examiner
Health Net Federal Services LLC
09.2015 - 09.2017
Intake Representative
Health Net Federal Services LLC
03.2014 - 04.2015
Sales Associate
Marshalls Department Store
09.2010 - 03.2014
Associate of Science - Medical Office Administration
Heald College
High School Diploma -
East Nicolaus High School
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