Donna Norris
Lithonia,GA
Summary
Possess more than 25 years’ experience in medical claims processing/customer service; problem solving & troubleshooting; benefits verification, contractual reimbursement interpretation & methodology. Consultation and training of provider office personnel on billing and filing requirements, benefits verification. Expert level experience in Medicare, Medicaid, Commercial insurance processing and Third-Party Liability (TPL) methodologies. Familiarity with government regulations and applicable reimbursement laws and regulations. Thorough knowledge of ICD-9/10, HCSPCS, DRG, CPT coding principles. Experience using MS Office Suite applications. Self-starter with great attention to detail, highly dependable, and exceptional interpersonal skills.
Overview
25
25
years of professional experience
Work History
Senior Billing Analyst
Gainwell Technologies (Formerly Hewlett Packard and DXC Technologies)
06.2014 - Current
- Utilize excel to process mass adjustments and billing for hospitals and healthcare providers across the eastern region
- Advise clients of billing and filing requirements in order to support various company-wide initiatives aimed at reducing intake errors during initial processing
- Present results to team’s global management and write requested executive summaries detailing value propositions and strategy to present to senior leadership
- Ensure financial documents are posted in compliance with contractual obligations
- Work with DCH reviewing and correcting medical edits resulting in the recoupment of payments
- Advise providers and provider office personnel on technical requirements around claims’ submission
- Actively support process involving PeachCare for Kids and GA Families CMO's (TPL)
- Collaborate with hospitals and providers on claims research and benefits verification
- Upload payments to providers or recoupments to Medicaid
- Process Medicaid claims, Medicare payments, and other COB in support of members’ TPL statuses
- Conduct reviews to foster ongoing compliance with federal and local regulations
- Verification of EOB’s, DMA’s and ICN’s
- Investigate providers’ claims for overpayments, denials, underpayments; and, validation of DRG, CPT, ICD9, and ICD10 coding
- Process all aspects of claims processing including allowable amounts, deductibles, and UB0 and CMS-1500 status validation.
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
- Provided primary customer support to internal and external customers.
- Reinforced established quality control standards and followed procedures for optimal customer interactions.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Updated account information to maintain customer records.
- Answered customer telephone calls promptly to avoid on-hold wait times.
Macy’s RFID Specialist and Support Staff
Macy’s Stonecrest Mall
01.2011 - 01.2016
- Performed RFID Audits in various departments
- Merchandised different departments
- Processed and secured merchandise shipments
- Completed markdowns on merchandise going on sale
- Recovery and Customer Service.
Customer Service Specialist
LiveOps
01.2006 - 01.2011
- Processed inbound calls from Infomercials
- Processed outbound calls and Sales
- Scheduled appointments.
Teacher
Solid Foundation Home School
01.2006 - 01.2007
- Taught math, reading, grammar, science and history to 1st & 2nd grade students.
Medicare and Medicaid Claims Specialist
Grady Health System
01.2005 - 01.2006
- Processed claims and Billing
- Coded bills using DRG, HCSPCS, ICD9 and CPT codes
- Provided customer service to doctors, insurance groups, hospitals and patients.
Medical Claims Specialist
HCA
01.2000 - 01.2005
- Processed Medical Claims and Monitored contract exceptions for appropriate reimbursement
- Ensured accuracy of auto-posted contractual
- Verified accuracy of Modeling Contracts, Insurance reimbursement and processed stop-loss percentage rates
- Performed online cashiering, verified Managed Care Claims according to Insurance Contracts; Customer Service and Workers Compensation.
Education
Bachelor of Science, Social Science (Public Administration) -
Florida Agriculture and Mechanical University
Tallahassee, FL01.1986
Skills
- Dispute Resolution
- Data Management
- Accounts Receivable
- Advanced Excel
References
Available Upon Request
Timeline
Senior Billing Analyst
Gainwell Technologies (Formerly Hewlett Packard and DXC Technologies)
06.2014 - Current
Macy’s RFID Specialist and Support Staff
Macy’s Stonecrest Mall
01.2011 - 01.2016
Customer Service Specialist
LiveOps
01.2006 - 01.2011
Teacher
Solid Foundation Home School
01.2006 - 01.2007
Medicare and Medicaid Claims Specialist
Grady Health System
01.2005 - 01.2006
Medical Claims Specialist
HCA
01.2000 - 01.2005
Bachelor of Science, Social Science (Public Administration) -
Florida Agriculture and Mechanical University
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