Dwan Brown
Savannah,GA
Summary
Goal driven, compassionate, and accountable professional with over 20 years of related, hands-on experience in fast paced settings. Hard working and reliable with a full understanding of Billing, Appeals, Medical Terminology, ICD-10-CM and CPT coding procedures. Excellent data entry skills allow for accurate coding of medical information, billing practice and provided care. Seeking a challenging key support role in health care administration where several years of experience will contribute to the success of the organization.
Overview
25
25
years of professional experience
Work History
Appeals Coordinator
Irhythm Technologies
San Francisco, CA
01.2022 - Current
- Responsible and accountable for reviewing appeal and grievance ensuring compliance with company policies and contracts as well as State, Federal and Health Plan regulatory requirements for commercial lines of business.
- Oversee and monitoring and review appeals and grievance concerns from members & provider.
- Ensured that provider and member appeals were processed according to their health plans and policies.
- Work with all commercial and government payers on behalf of physician practices, hospitals, and clinics to understand denial reasons, and prevent future denials or underpayments.
- Ensured compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure.
- Interact daily with Clients, Patients, HIM Departments, Providers and Staff as necessary to effectively resolve appeals, complaints and quality of care or service issues.
- Ensured that all legal, regulatory and policy requirements were met by keeping informed of changes and by implementing necessary controls and/or programs to meet requirements.
- Created, composed and maintained appeal response templates.
Claims Specialist II
RSource
Boca Raton, FL
06.2021 - 01.2022
- Reviewed new files to determine current status of injury claim and to develop plan of action for researching UB04 denials as underpayments.
- Followed up with customers/clients on unresolved issues.
- Conducted full claim investigations and reported updates and legal actions.
- Escalated files with significant indemnity exposure to supervisor for further investigation.
- Managed large volume of medical claims on daily basis.
- Submitted electronic/paper claims documentation for timely filing.
- Worked aged accounts greater than 120 days with high dollar amounts.
- Review payer contracts for proper reimbursement.
- Processed medical records requests from outside providers according to facility, state, and federal law.
- Uploaded physician and hospital progress notes, history, and physicals into electronic medical records.
- Evaluated aging reports to identify members / clients to be included in monthly outbound collection calls.
- Designed and produced reports to highlight and explain collection issues and balances due, working with clients and attorneys simultaneously.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Billing Coordinator
Shrink Savannah
Savannah , GA
12.2017 - 05.2021
- Responsible and accountable for supervision of claims auditing ensuring compliance with company policies and contracts as well as State, Federal and Health Plan regulatory requirements for commercial and senior lines of business.
- Oversaw monitoring and review of claim rep adjudication quality reports.
- Ensured that provider and member appeals were processed according to their health plans and policies.
- Confirmed appointments for Evaluations, Injections and Psychotherapy
- Ensure patients were checked timely m for various sessions.
- Ensured compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen internal processing.
- Monitored data base to ensure all physicians and programs enrolled remained credentialed.
- Ensured that all legal, regulatory and policy requirements were met by keeping informed of changes and by implementing necessary controls and/or programs to meet requirements.
- Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
- Performed account payment procedures and provided information regarding outstanding balances.
- Kept vendor files accurate and up-to-date to expedite payment processing.
- Verified accuracy of accounts payable payments, resulting 30% reduction in payment errors and check reissues.
- Reconciled accounts receivable to general ledger.
Accounts Receivable Representative
Brasseler USA ®
Savannah , GA
04.2014 - 11.2017
- Consistently met established productivity, schedule adherence and quality standards.
- Reviewed accounts on monthly basis to assess aging and pursue collection of funds.
- Managed over 50 calls per day from customers, suppliers, and dentist local and abroad.
- Reconciled accounts receivable ledger to verify payments and resolve variances.
- Communicated with customers to identify and resolve outstanding payments.
- Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
- Responded to customer requests for products, services, and company information.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Insurance Reimbursement Specialist
Atlantic Foot And Ankle Associates
Savannah, GA
03.2012 - 08.2014
- Coordinated workers compensation cases involving occupational illness or injury via employees, supervisors or workers compensation carrier.
- Posted payments to accounts and maintained records.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Followed up with customers on unresolved issues.
- Conducted full claim investigations and reported updates and legal actions.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
Appeals and Grievances Coordinator
Blue Cross Blue Shield Of TN
Chattanoga, TN
01.1998 - 08.2003
- Submitted verbal and written notification to members and providers on approval or denials.
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
- Provided outreach for additional information for appeals and grievances.
- Entered appeal requests in appeals module.
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Monitored and updated claims status in claims processing system.
- Followed up on denied claims to verify timely patient payment and resolution.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Coordinated with senior specialist to compose appeal responses.
- Acted as a departmental resource on appeals matters.
Education
Medical Billing - Health Information Management
Kaplan College - Indianapolis
Indianapolis, IN12.2024
Diploma -
Hilton Head High School
1992
Skills
- Auditing
- Billing
- Customer Service
- Diagnosis and Procedures
- Appeals
- Accounts Receivables
- Facets, SalesForce, Epic, Zio Reports, Waystar, MediTech, Simple Practice, Practice Fusion, Collaborate MD, Kareo, NextGen, GE Centricity, MS Suite, Xifin, SMS, DDE, Emedeon, Ciox, Change Healthcare, Medicare, Commercial and Government insurance portals
Accomplishments
- Extensive knowledge of medical terminology across a broad range of medical practice areas.
- Highly organized and independent; able to effectively coordinate tasks to accomplish projects with timeliness and creativity.
- Strong understanding of ICD-10 CM and CPT requirements and procedures.
- Proven ability to work creatively and analytically in a problem-solving environment.
Timeline
Appeals Coordinator
Irhythm Technologies
01.2022 - Current
Claims Specialist II
RSource
06.2021 - 01.2022
Billing Coordinator
Shrink Savannah
12.2017 - 05.2021
Accounts Receivable Representative
Brasseler USA ®
04.2014 - 11.2017
Insurance Reimbursement Specialist
Atlantic Foot And Ankle Associates
03.2012 - 08.2014
Appeals and Grievances Coordinator
Blue Cross Blue Shield Of TN
01.1998 - 08.2003
Medical Billing - Health Information Management
Kaplan College - Indianapolis
Diploma -
Hilton Head High School
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