DOMINIQUE DUBOIS
NASHUA,NH
Summary
Billing specialist with 4+ years of experience in healthcare billing and reimbursement processes for Health insurance, workers compensation, and auto insurance. Proficient in Epic, Meditech, LogixAllscripts, and Salesforce CRM, with a proven track record of optimizing reimbursement and enhancing financial accuracy. Strong problem-solving skills and attention to detail, ensuring compliance and efficient workflow in high-stress environments.
Overview
8
8
years of professional experience
Work History
CLAIMS ANALYST (CONTRACT)
Pro Medical LLC
09.2024 - Current
- Obtain and ensure accuracy of UB and HCFA forms for complex claims.
- Verify client demographics in Meditech/Logix for insurance validation.
- Utilize outside sources to investigate possible coverage.
- Confirm claims and benefits with carriers, workers comp/auto carrier.
- Adjust claims according to the type of bill being billed to the carrier.
- Submit claims through Jopari/Waystar/availity/USPS/ or fax.
- Follow up with carrier on the status of bills.
- Resubmit claims to carrier for reconsideration of payment/ additional payment according to estimated rate of return.
- Post payments according to the PPO reductions/or state fee schedule.
- Review settlement offers from attorneys and accept/counter offer according to estimated rate of return.
- Work accounts to obtain a $0 balance for the client.
REIMBURSEMENT SPECIALIST (CONTRACT)
Argenta Advisors
04.2024 - 09.2024
- Manage patient cases in Salesforce CRM, ensuring accurate tracking and documentation for optimal case management.
- Submit prior authorization and appeal letters, for incoming cases on new technologies/products that are new to the market.
- Review patient and clinical documentation for medical reviews, maintaining regulatory compliance.
- Research payer policies and regulations based on product referral. Provide client and Market Access Leaders with payer and RBM policy for referred product.
- Provide client and Market Access Leaders with general reimbursement and coding support based on referred product.
- Generate a benefit verification form for clients to provide to the patients
Medical Billing Specialist
Merrimack Valley Cardiology
02.2022 - 04.2024
- Request and track pre-authorizations for 13 physicians, ensuring timely approvals and compliance.
- Prepare and arrange medical records, enhancing accuracy for procedure authorizations.
- Verify insurance eligibility through payor portals for commerical/medicaid/medicare ensuring adherence to payer policy.
- Communicate with physicians on the status of prior authorizations to streamline patient care and reduce delays.
- Manage work queues for cardiac procedures such as Heart catheterization, cardioversion, ablation, echocardiogram, nuclear stress test etc., maintaining organization for all upcoming appointments/procedures.
- Submit UB-HCFA forms through clearinghouse Waystar.
- Review and adjust rejected claims in clearinghouse accordingly.
- Investigate denied claims for resubmission for payment.
- Post remits and resolve claim issues, maximizing reimbursement.
- Run monthly accounting reports for payers, tracking collection progress to update tracking sheets.
- Generate and manage bills for coinsurance, copay, and deductibles.
PARAPROFESSIONAL
Lighthouse School INC
01.2017 - 01.2022
- Collaborated with special education teachers to tailor treatments, enhancing student engagement and learning
- Developed assignments aligned with IEP goals, ensuring individualized student progress
- Attended specialized training for various disabilities, enhancing support strategies for students
- Organized school event memos, improving communication and participation among staff and students
- Built strong relationships with students, fostering a supportive and inclusive learning environment
Education
BACHELORS OF SCIENCE - HEALTHCARE INFORMATION MANAGEMENT
SNHU
Manchester, NH10.2022
ASSOCIATES - MEDICAL ASSISTANT
Hesser Community College
01.2012
Skills
- Accounts receivable
- Organizational skills
- Reimbursement optimization
- Prior authorization
- Claims management
- Analytical
- Payment processing
- ICD-10
- CPT
- HCPCS
- Problem solving
- Communication skills
Timeline
CLAIMS ANALYST (CONTRACT)
Pro Medical LLC
09.2024 - Current
REIMBURSEMENT SPECIALIST (CONTRACT)
Argenta Advisors
04.2024 - 09.2024
Medical Billing Specialist
Merrimack Valley Cardiology
02.2022 - 04.2024
PARAPROFESSIONAL
Lighthouse School INC
01.2017 - 01.2022
ASSOCIATES - MEDICAL ASSISTANT
Hesser Community College
BACHELORS OF SCIENCE - HEALTHCARE INFORMATION MANAGEMENT
SNHU
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