Felicia Vaughn
Summary
Dynamic professional with extensive expertise in claims auditing, dedicated to ensuring accuracy and compliance throughout evaluation processes. Proven success in identifying discrepancies, streamlining workflows, and enhancing overall claim quality. Committed to fostering team collaboration, achieving measurable results, and adapting to evolving business needs. Proficient in regulatory compliance, data analysis, and continuous process improvement, embodying a reliable and results-driven approach.
Overview
13
13
years of professional experience
Work History
Accounts Receivable Coordinator
Cintas
12.2024 - Current
- Reconciled customer accounts, resolving discrepancies efficiently.
- Managed invoicing processes to ensure timely billing and collections.
- Led monthly reporting on aging accounts and collection efforts.
- Fostered relationships with clients to improve payment compliance and satisfaction.
- Supported month-end closing procedures by reconciling accounts receivable ledgers and preparing aging reports for management review.
- Partnered with cross-functional departments to resolve discrepancies in customer accounts, promoting a cohesive work environment.
- Strengthened relationships with key clients by providing exceptional service in addressing inquiries regarding account balances or payment issues.
- Reduced outstanding debts through consistent follow-up on overdue invoices and negotiating payment plans.
- Facilitated timely account updates by promptly processing adjustments for credits, discounts, and writeoffs.
Claims Processor
UnitedHealth Group
10.2018 - 05.2024
- Processed insurance claims efficiently, ensuring compliance with company policies and state regulations.
- Reviewed claim submissions for accuracy, identifying discrepancies to minimize errors and streamline processing.
- Coordinated with internal departments to gather necessary documentation for timely claims resolution.
- Trained new staff on claims processing protocols and software systems to enhance team performance.
- Implemented process improvements that reduced claim turnaround time and increased customer satisfaction rates.
- Analyzed complex claims cases, providing recommendations for resolution based on policy coverage and guidelines.
- Monitored claim status updates, proactively communicating with clients regarding progress and required actions.
- Maintained detailed records of all claims processed, ensuring data integrity within the claims management system.
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
- Reduced claim processing time for faster customer service and improved satisfaction rates.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
Claims Quality Auditor
Humana
11.2012 - 12.2016
- Conducted thorough quality audits to ensure compliance with organizational standards and regulatory requirements.
- Analyzed claims processing workflows to identify inefficiencies and recommend process improvements.
- Collaborated with cross-functional teams to enhance claim accuracy and reduce error rates.
- Developed training materials and conducted workshops for staff on best practices in claims management.
- Led root cause analysis sessions to address recurring issues in claims adjudication and processing.
- Evaluated performance metrics to inform strategic decisions aimed at improving service delivery outcomes.
- Mentored junior auditors, fostering a culture of continuous improvement and professional development.
- Streamlined reporting processes by implementing new auditing tools and technologies for enhanced efficiency.
- Implemented effective coaching strategies to address identified areas of opportunity for individual claims representatives.
- Maintained up-to-date knowledge of industry regulations and changes, ensuring compliance within the organization''s claim handling procedures.
Skills
Claims Auditing & Quality Assurance
Medical Claims Processing
CPT, ICD-10, and HCPCS Coding Knowledge
Insurance Verification & Eligibility
Provider Relations & Support
Claims Research & Resolution
Data Entry & Accuracy
Prior Authorization & Denials Management
Report Reconciliation & Data Validation
Process Improvement & Workflow Optimization
Problem Solving & Critical Thinking
Remote Work & Virtual Communication Tools
Timeline
Accounts Receivable Coordinator
Cintas
12.2024 - Current
Claims Processor
UnitedHealth Group
10.2018 - 05.2024
Claims Quality Auditor
Humana
11.2012 - 12.2016