Summary
Overview
Work History
Education
Skills
Accomplishments
Careerqualifications - Skills
Timeline
Generic

Donna Tomas

Roselle,Illinois

Summary

Highly organized and dependable candidate with a demonstrated ability to effectively manage multiple priorities while maintaining a positive attitude. Willingness to take on additional responsibilities to help the team achieve its goals showcases a strong team player mentality. Strong attention to detail and organizational skills make me a valuable asset, ensuring accuracy in every task. Excels at handling multiple projects simultaneously, showcasing ability to thrive in fast-paced environments. 2 Years of success in the Revenue Cycle industry as a seasoned Business Analyst, expert in business and systems requirements, user acceptance testing, and end-user training. Proven track record of leveraging past lessons to inform future decision-making, making me an accomplished professional in my field.

Overview

15
15
years of professional experience

Work History

Associate Business Analyst (Promoted)

Optum Insight
06.2023 - Current
  • Provide support when compiling and reporting information and assume responsibility for data integrity among various internal groups and/or between internal and external sources
  • Conduct and manage outcomes of various studies that include analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning
  • Intermediate level of proficiency with PC based software programs and automated database management systems required (Excel, Access, PowerPoint)
  • Evaluate, interpret and analyze data and business process and analyze/monitor reports
  • Demonstrated process improvement, workflow, benchmarking and / or evaluation of business processes required.
  • Develop strategic workflow and Provide Training to enhance quality of work

Denial Management Specialist / Sr Acct Receivable Clerk

Dupage Medical Group
08.2020 - 06.2022
  • Reduced operational costs by identifying areas for improvement and implementing cost-saving measures.
  • Led staff training initiatives that enhanced employee skillsets and job satisfaction levels.
  • Enhanced team productivity by providing consistent feedback and guidance on performance goals.
  • Facilitated regular team meetings focused on problem-solving discussions that led to practical solutions.
  • Delivered successful projects within deadlines through effective time management and resource allocation.
  • Conducted comprehensive market research to identify opportunities for expansion and growth.
  • Collaborated closely with executive leadership to develop long-term strategic plans aligned with company objectives.
  • Coordinated with internal departments to streamline operations and improve overall company efficiency.
  • Generated reports detailing findings and recommendations.
  • Conducted regular reviews of operations and identified areas for improvement.
  • Educated staff on organizational mission and goals to help employees achieve success.
  • Evaluated employee performance regularly, providing constructive feedback for continuous improvement.

Billing Specialist II

Pedia Trust, LLC.
04.2018 - 06.2020
  • Researched and resolved billing discrepancies to enable accurate billing.
  • Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within th department.
  • Maintained detailed records of each account''s payment history, providing easy access to information for audit and analysis purposes.
  • Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.
  • Improved customer satisfaction with prompt and clear communication regarding their billing inquiries.
  • Identified opportunities for process improvement, leading to more streamlined billing operation.
  • Facilitated staff training on new billing software, enhancing team productivity and billing accuracy.
  • Collaborated with healthcare team to ensure billing codes were accurately applied, optimizing reimbursement from insurance companies.
  • Enhanced interdepartmental communication to ensure accuracy and completeness of billing information.
  • Maintained up-to-date knowledge of billing regulations and compliance requirements, ensuring adherence to legal standards.
  • Responded to customer concerns and questions on daily basis.
  • Generated monthly billing and posting reports for management review.

Biller - Patients Accounts/Insurance Follow Up

Boncura Solutions/ Dupage Medical Group
08.2016 - 04.2018
  • Knowledgeable with payor in claims processing
  • Verify patient coverage and eligibility
  • Review and process explanation of benefits
  • Handle denials and appeals, correct and re-bill claims
  • Follow up with insurance companies to receive payments on aged accounts
  • Identifies coding errors and facilitates clinical coding review
  • Prepares and files appeals timely
  • Completes Request for Reconsideration forms following payor requirements and submits within timely filing periods
  • Participates in Special Projects to help cleaned up AR
  • Insurance Follow Up unit policies and procedures
  • Researches delinquent claims to identify payer and/or claim office trends, applies approved payer rule adjustments, resubmits missing claims, and reports findings to supervisor
  • And all other Responsibilities
  • Train New Employees.

Medical Biller & Medical Records

Deerfield Dermatology Ltd.
02.2015 - 04.2016
  • Verified insurance of patients to determine eligibility.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Filed and updated patient information and medical records.
  • Ensured timely payments from insurance providers through submission of accurate and complete claims.
  • Posted payments and collections on regular basis.
  • Collected payments and applied to patient accounts.
  • Enhanced revenue collections for medical practice with diligent follow-ups on unpaid claims.
  • Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
  • Reduced claim denials by meticulously reviewing patient insurance information and coding practices.

Front Desk / Receptionist

Deerfield Dermatology Ltd.
06.2009 - 04.2015
  • Managed high-volume phone calls, directing inquiries to appropriate personnel for prompt resolution.
  • Enhanced customer satisfaction by providing efficient and professional front desk services.
  • Confirmed appointments, communicated with clients, and updated client records.
  • Resolved customer issues quickly and notified supervisor immediately when problems escalated.
  • Maintained accurate records of visitor logs for security purposes and compliance with company policies.
  • Increased customer satisfaction by promptly addressing and resolving inquiries and concerns.
  • Handled sensitive customer information with confidentiality, adhering to company privacy guidelines.

Education

Certificate - Billing And Coding

College of DuPage
Glen Ellyn, IL
09.2017

Bachelor of Science - Bachelor in Business Administration

Polytechnic University of The Philippines, Taguig City
Philippines
04.2004

Skills

  • Microsoft Word, PowerPoint and Excel expertise, Pivot tables, Tableau proficiency, Data Mining
  • Business process improvement, Strategic Planning & Workflow Analysis & Operational Reporting
  • SQL Proficiency, Data Analysis
  • User Acceptance Testing, Process Mapping
  • Process Improvement, Quality Assurance & Internal Auditing
  • Project & Operations Management
  • Attention to Detail, Self Motivation, Task Prioritization, Problem-solving, Multitasking abilities
  • Effective and Excellent Communication/ Written Communication, Teamwork and Collaboration

Accomplishments

  • Developed an organizational training and management strategy for 30+ employees as a Lead Analyst.

Careerqualifications - Skills

  • Decisive, contemplative, direct and confident
  • Assertive self-starter
  • Generates innovative and creative ideas
  • Open for a new career opportunity and supervisory level
  • Computer Literate (Excel, Ms Word, Power Point, Pivot), EPIC, ADP, Familiar with Healthcare Payor website and portal.
  • Highly Motivated in terms of work, Good interpersonal relationship and Dynamic, Pays strong attention to details and maintains high degree of accuracy, Can be able to multi task
  • Knowledgeable about ICD 10 and CPT Codes
  • Prior and Retro Authorization and Precertification Skills and Knowledge
  • Excellent communication, time/project management, problem solving, organizational, and analytical skills required.

Timeline

Associate Business Analyst (Promoted)

Optum Insight
06.2023 - Current

Denial Management Specialist / Sr Acct Receivable Clerk

Dupage Medical Group
08.2020 - 06.2022

Billing Specialist II

Pedia Trust, LLC.
04.2018 - 06.2020

Biller - Patients Accounts/Insurance Follow Up

Boncura Solutions/ Dupage Medical Group
08.2016 - 04.2018

Medical Biller & Medical Records

Deerfield Dermatology Ltd.
02.2015 - 04.2016

Front Desk / Receptionist

Deerfield Dermatology Ltd.
06.2009 - 04.2015

Certificate - Billing And Coding

College of DuPage

Bachelor of Science - Bachelor in Business Administration

Polytechnic University of The Philippines, Taguig City
Donna Tomas