Hi, I’m
Dominque Stewart
North Lauderdale,Fl
Summary
Sr. Claim processpr Billing and Collection Specialist with over 15 years of experience in healthcare industry providing various billing functions in efforts to resolve members accounts. My experience includes medical coding operative reports abstracting, insurance follow-up and collections, claims processing, charge entry, appeals, payment posting and insurance verification. My Goal is to excel in the healthcare industry reaching the highest obtainable goal which allows opportunity, advancement, and growth.
Overview
15
years of professional experience
Work History
UnitedHealthcareNorth Lauderdale, FL
Claim Processing Specialist
03.2019 - 03.2023
Job overview
- Managed large volume of medical claims on daily basis.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Paid or denied medical claims based upon established claims processing data.
- Meets productivity Standards of 50 account per day. Identify trends and provide feedback to management team.
- Special Projects with provider Configuration Team which included adding providers tax ID number and NPI number to multiple payers.
- Reviewed provider contracts to update claims submission for paper claims and electronic claims in the EPIC/ QXNT WorkQeues for complex HCFA 1500 and UB92.
- Attached the appropriate contracts/authorizations for complete claim submission per policies and procedures guidelines.
Florida Methodist HospitalNorth Lauderdale , FL
Claims Adjuster
01.2015 - 01.2020
Job overview
- Perform follow- up collections on Aging accounts in a
- Answered customer questions regarding deductibles.
- Prepared summaries of damage, payments and policy coverage.
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
Joe DiMaggio Children’s Hospital
Compliant Resolution Specialist
04.2008 - 12.2014
Job overview
- Review formal complaints from TDI/ HHSC which involves high level of research and investigation within a timeframe
- Create written resolution letters to TDI/HHSC regarding complaint issues from providers and members
- Resolve pharmacy complaint issues for members
- Resolve quality of service and quality of care complaints filed against providers
- Create acknowledge letters and notify members with 5 business days and resolve complaints issues with 30 days required by Texas Children’s Health policy and procedure guidelines
Education
Broward College
Associate Degree
Florida International UniversityMiami, FL
Bachelor of Science
Skills
Knowledge of ICD-9, ICD-10 and CPT Codingundefined
Timeline
Claim Processing Specialist
UnitedHealthcare
03.2019 - 03.2023
Claims Adjuster
Florida Methodist Hospital
01.2015 - 01.2020
Compliant Resolution Specialist
Joe DiMaggio Children’s Hospital
04.2008 - 12.2014
Broward College
Associate Degree
Florida International University
Bachelor of Science
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