Kandi Miles
Conyers
Summary
Detail-oriented Claims Specialist and Client Delivery Professional with 10+ years of experience across healthcare operations, insurance verification, claims coordination, and payer communications. Proven ability to analyze discrepancies, resolve complex claim issues, ensure benefit accuracy, and maintain compliance with payer and organizational standards. Strong background leveraging insurance portals, EHR systems, and cross-functional collaboration to improve claim outcomes, reduce errors, and accelerate reimbursement timelines.
Overview
10
10
years of professional experience
Work History
Outbound Specialist (Contract)
Sword Health
04.2025 - Current
- Analyze insurance verification and enrollment data to identify claim-related discrepancies, improving data accuracy and reducing downstream processing errors.
- Review customer and payer interactions to optimize outreach strategies, increasing engagement and resolution effectiveness.
- Conduct root-cause analysis on enrollment and verification issues, delivering actionable insights that enhance operational efficiency and compliance.
- Mentor team members on best practices for insurance verification, documentation standards, and quality assurance.
Business Relationship Manager (Contract)
MHK
07.2024 - 10.2024
- Partnered with health plans and internal stakeholders to support benefit accuracy and claims-related communications.
- Analyzed client feedback and claims trends to refine benefit designs, improve operational alignment, and strengthen client retention.
- Coordinated cross-functional teams to streamline IT and operational workflows impacting claims processing and service delivery.
- Strengthened payer and client relationships to ensure alignment with coverage policies and reimbursement requirements.
Client Delivery Manager
Alight Solutions
10.2019 - 03.2024
- Performed comprehensive benefits verification and eligibility reviews to support accurate claims processing and timely service delivery.
- Communicated directly with insurance carriers to clarify coverage, resolve claim issues, and ensure compliance with verification standards.
- Managed Jira workflows to track claim inquiries, verification requests, escalations, and resolution timelines across multiple clients.
- Streamlined onboarding and verification workflows, reducing delays and improving first-pass claim accuracy.
- Served as a subject matter resource for claims-related inquiries, documentation standards, and client escalations.
Patient Care Coordinator/Referral Coordinator
Emory Healthcare
07.2019 - 10.2019
- Established and led referral coordination workflows, ensuring proper authorizations and claim readiness prior to service delivery.
- Utilized AthenaOne and payer portals to submit authorizations, verify benefits, and retrieve clinical documentation.
- Developed tracking tools that reduced referral errors and improved claim approval rates.
- Collaborated with providers and payers to prevent denials and ensure continuity of care.
Lead Registration Associate
Children's Healthcare of Atlanta
10.2017 - 07.2019
- Oversaw front-end registration accuracy, directly impacting downstream claims and reimbursement performance.
- Analyzed registration and insurance data to identify trends contributing to denials and billing delays.
- Led recall project that reduced follow-up visits by 20%, improving patient satisfaction and billing efficiency.
- Ensured compliance with insurance documentation, eligibility verification, and audit standards.
Scheduler Trainer
WellStar Health System
12.2016 - 10.2017
- Trained staff on scheduling, insurance verification, and documentation workflows supporting clean claim submission.
- Served as liaison between patients, providers, and payers to resolve authorization and billing concerns.
- Improved claim accuracy by reinforcing correct appointment setup and insurance data entry practices.
- Fostered a supportive onboarding environment to accelerate productivity and quality standards.
Front Desk Coordinator Intern
Unified Women’s Health
06.2016 - 12.2016
- Verified insurance eligibility and benefits to support accurate billing and claim submission.
- Improved patient intake efficiency and reduced administrative errors impacting revenue cycle performance.
- Monitored scheduling metrics to optimize patient flow and documentation accuracy.
- Coordinated with clinical teams to ensure timely communication and continuity of care.
Education
Master of Science - Healthcare Administration
Grand Canyon University
Phoenix, AZ12.2018
Bachelor of Science - Healthcare Administration
Clayton State University
Morrow, GA05.2016
Skills
- Claims Processing, Auditing, and Resolution
- Insurance Verification and Eligibility
- Benefits Interpretation
- Payer, Provider, and Client Communication
- Discrepancy and Root-Cause Analysis
- Authorization and Referral Management
- HIPAA and Regulatory Compliance
- Workflow Optimization and Process Improvement
- Data Analysis and Reporting
- Jira, Salesforce, Zendesk, Epic, AthenaOne, and Excel
Timeline
Outbound Specialist (Contract)
Sword Health
04.2025 - Current
Business Relationship Manager (Contract)
MHK
07.2024 - 10.2024
Client Delivery Manager
Alight Solutions
10.2019 - 03.2024
Patient Care Coordinator/Referral Coordinator
Emory Healthcare
07.2019 - 10.2019
Lead Registration Associate
Children's Healthcare of Atlanta
10.2017 - 07.2019
Scheduler Trainer
WellStar Health System
12.2016 - 10.2017
Front Desk Coordinator Intern
Unified Women’s Health
06.2016 - 12.2016
Bachelor of Science - Healthcare Administration
Clayton State University
Master of Science - Healthcare Administration
Grand Canyon University