Summary
Overview
Work History
Education
Skills
Personal Information
References
Timeline
Generic

Donneasha Hall

Tampa,FL

Summary

Skilled and energetic individual can work independently and use innovative ways to create new processes and provide guidance to exceed desired expectations. Dedicated to using effective solving skills and meet business goals to communicate in a clear, concise manner and have a proven track record of results. Role model and a driven leader that manages wisely in order to achieve maximum results that fully contribute to the organization's efforts to achieve success. Thirteen years strong background in customer driven environment Leverage skills to create open lines of communication, building key business relationships and provide user friendly customer driven experiences. Ability to make effective career-oriented decisions and put company's objectives in foremost Position. Experienced Claims Examiner with deep understanding of managing insurance claims and investigating discrepancies. Strong ability to interpret insurance policies, verify coverage details and negotiate claim settlements effectively. Consistently demonstrated capacity to improve efficiency in claims processing within previous roles. Possess excellent analytical skills, problem-solving abilities, and sound judgement for fair resolution of matters. Experienced in fast-paced environments and adaptable to last-minute changes. Thrives under pressure and consistently earns high marks for work quality and speed.

Overview

8
8
years of professional experience

Work History

Claims Examiner

ImageNet LLC
10.2023 - Current
  • Working to resolve members billing
  • Keeps equipment operational by following established procedures, reporting malfunctions
  • Updates job knowledge by participating in educational.
  • Customer Service
  • Serving Customers
  • Processed claims payments and denials in accordance with company procedures.
  • Verified and analyzed claims settlement data to ensure validity.
  • Provided excellent customer service, resolving claimant concerns and queries promptly.
  • Managed caseload effectively, ensuring timely review and resolution of claims.
  • Maintained up-to-date knowledge about changes in healthcare reform legislation affecting provider reimbursements.
  • Completed required investigations on referred files within established timeframes.
  • Performed data entry into the computer system to record information regarding claim status.
  • Reviewed invoices for accuracy before submitting them for payment.

Member Relations Representative

Matrix Medical Network
Tampa, US
10.2021 - 10.2023
  • Processed and recorded new policies and claims
  • Assessed medical claims for compliance with regulations and corrected discrepancies
  • Reviewed provider coding information to report services and verify correctness
  • Paid or denied medical claims based upon established claims processing criteria
  • Trained new staff members on scheduling processes and protocols.
  • Developed systems for tracking patient appointment scheduling data.
  • Maintained updated records of all scheduled appointments.
  • Streamlined communication channels to ensure timely updates and changes to schedules were disseminated efficiently.
  • Provided information regarding medical services, fees, and payment options.
  • Created and enforced scheduling policies and procedures to standardize operations.

Fraud Prevention Analyst

Florida Credit Union
Tampa, US
07.2017 - 08.2021
  • Processed and recorded new policies and claims
  • Assessed medical claims for compliance with regulations and corrected discrepancies
  • Reviewed provider coding information to report services and verify correctness
  • Paid or denied medical claims based upon established claims processing criteria

Education

High School Diploma -

Freedom High School
01.2011

Skills

  • Customer service
  • Medical coding
  • Claims processing
  • Data verification
  • Healthcare procedures
  • Verbal communication
  • CRM Systems Knowledge
  • Claimnet
  • QNXT
  • SYNERGY
  • H-Drive
  • Data Rates
  • One Note
  • Computer skills
  • Google Chrome
  • Webex
  • Microsoft Edge

Personal Information

Authorized To Work: US

References

References available upon request.

Timeline

Claims Examiner

ImageNet LLC
10.2023 - Current

Member Relations Representative

Matrix Medical Network
10.2021 - 10.2023

Fraud Prevention Analyst

Florida Credit Union
07.2017 - 08.2021

High School Diploma -

Freedom High School
Donneasha Hall