Dyneeshur Miller
Temple,TX
Summary
Highly analytical and detailed-oriented Healthcare Management professional with a B.S. in Healthcare Management Informatics and over 9 years of success in remote, autonomous work environments. Proven expertise in complex claims processing, financial auditing, and system configuration. Highly proficient in leveraging advanced Excel, Encoder Pro, QNXT, Pega, and clinical data analysis to reconcile specialized fee schedules, optimize revenue cycle workflows, and resolve provider contract discrepancies. Recognized for a valedictorian work ethic and an unique ability to bridge the gap between clinical practices and backend financial compliance to drive data integrity, accuracy, and operational efficiency.
Overview
18
18
years of professional experience
Work History
Appeal and Grievance Specialist
Molina Healthcare
01.2022 - Current
- Financial & System Auditing: Audit and resolve complex provider appeals and payment disputes by cross-referencing commercial contracts, CMS guidelines, and state fee schedules to secure 100% system configuration accuracy.
- Complex Claims Logic: Calculate accurate reimbursement rates for high-level claims categories, executing specialized math for anesthesia equations and complex inpatient/outpatient pricing data sets.
- Process Optimization: Proactively identify systemic configuration breakages and database bottlenecks; initiate cross-functional projects and log IT tickets to remediate outdated provider enrollment and secondary payer information.
- Technical Compliance: Utilize specialized analytics tools including Encoder Pro, CCI edits, and Cotiviti review platforms to maintain regulatory and internal compliance standards.
- Stakeholder Engagement: Facilitate external provider meetings via Microsoft Teams to communicate complex resolution pathways, address contract variances, and align operational policies.
Appeal and Grievance Specialist
Cigna
07.2020 - 12.2021
- Managed daily financial administrative workflows with high data integrity, leveraging advanced Microsoft Excel functions to track, sort, and manage critical operational metrics.
- Maintained 100% remote communication frameworks and executed independent project workflows across highly distributed national internal teams.
Senior Appeals Processing Representative
Medix
07.2019 - 07.2020
- Authorization Processing: Processed and validated timely claims authorizations assessed by Senior Coordinators and approved by TMHP for Texas StarPlus and MMP members to ensure compliance.
- Revenue Recovery: Contributed to the strategic recovery of overpayments and inaccurate billing by auditing and validating physician and personal attendant documentation against EVV systems of record.
- Eligibility Verification: Verified insurance eligibility, validated requested services, and cross-referenced HCPCS and modifier codes to guarantee official authorization completion, completely avoiding financial service interruptions.
Senior Payment Processor
DXC Technology formally CSC
Irving, USA
06.2013 - 07.2019
- Financial Reconciliation: Balanced high-volume lockboxes for a major financial institution, posted client payments, and conducted deep-dive research to resolve and match unidentified revenue with correct accounts.
- Contract Auditing: Evaluated and audited complex auto loan contracts to guarantee absolute data completeness, strict regulatory adherence, and proper record-keeping execution.
- System Administration: Processed financial account extensions within the system of record while strictly maintaining data integrity standards.
- Leadership & Hiring Support: Selected to deliver comprehensive onboarding and technical training to incoming personnel, and partnered with leadership to conduct candidate selection interviews.
Complaint Compliance Coordinator
Insight Global
Plano, USA
11.2012 - 06.2013
- Compliance Auditing: Audited transactional data and process flows by cross-referencing multi-tiered system records to guarantee absolute compliance with FDA regulations, identifying data gaps to mitigate corporate risk.
- Remediation Logging: Coordinated data record updates to address recurring configuration discrepancies and asset shortages, resulting in clean file closures.
- Queue Optimization: Partnered with cross-functional operational teams to clear inventory bottlenecks, optimizing processing queues to resolve high-volume historical compliance backlogs.
Senior Production Coordinator
Capital One Auto Finance
Plano, USA
04.2009 - 05.2013
- Pilot Project Leadership: Partnered in test pilot initiatives to enhance auditing infrastructure, reducing file errors by 70% and accelerating production capability by 98% within the first quarter.
- Analytics & Reporting: Compiled complex monthly metrics to generate trend projection reports for upper management to easily identify performance patterns.
- Regulatory Compliance: Trained account managers and quality assurance staff in departmental practices according to SOPs and OCC regulations in payment processing and account maintenance.
- Fraud Mitigation: Audited legal documents to identify discrepancies, missing information, or fraudulent signatures to safely approve and complete high-risk modifications.
Inventory Clerk
Kelly Services
Plano, USA
12.2008 - 02.2009
- Inventoried informational documents to ensure availability for Medicare enrollment packet completion.
- Logged orders and tracking information in designated systems for organized record keeping.
- Proposed and implemented color-coded filing methods, enhancing inventory accuracy and reducing processing time.
- Reduced backlogged requests by managing faxing, copying, and electronic imaging for outgoing packets.
Education
Bachelor of Science - Healthcare Management, Health Informatic
Colorado Technical University
Colorado Springs, CO01-2020
Medical Assistant Diploma - Anatomy, Invoices, Front/Back Office
Remington College
Fort Worth, TX02-2003
Skills
- Financial & Revenue Cycle Analysis: Inpatient/Outpatient Pricing, Anesthesia Calculations, Coordination of Benefits (COB), Lockbox Reconciliation
- Auditing & Compliance: Contract Configuration, CMS & State Fee Schedules, Auto-Loan Compliance, FDA/MDR Regulations, CCI Edits
- Systems & Software: QNXT, PEGA, Encoder Pro, Cotiviti, On-Base, Salesforce, Claim Shark, ECHO Payment Systems
- Process Improvement: System Breakage Identification, Root Cause Analysis, Inventory Queue Management, Data Quality Assurance
- Leadership & Peer Training: Technical Onboarding, New Hire Mentorship, Talent Selection Support, Cross-Functional Team Building
Academic Coursework
- Professional Development
- Microeconomics
- Analytics
- Data Quality
- Healthcare Ethics
- Software Applications in Healthcare
- Principles of Team Building
- Project and Organizational management
Professional Highlights
- Exceeded Production & Compliance: Consistently achieved "Exceeds Expectations" ratings across all volume, quality, and accuracy metrics during annual professional evaluations.
- Data Integrity Champion: Maintained a 100% data audit accuracy standard over a consecutive 3-year performance period, earning formal commendations from management and state officials.
- Workflow Optimization Execution: Escalated monthly processing productivity from 30 to 1,200 submitted and approved complex file evaluations by engineering new quality checks and automated balancing workflows.
Timeline
Appeal and Grievance Specialist
Molina Healthcare
01.2022 - Current
Appeal and Grievance Specialist
Cigna
07.2020 - 12.2021
Senior Appeals Processing Representative
Medix
07.2019 - 07.2020
Senior Payment Processor
DXC Technology formally CSC
06.2013 - 07.2019
Complaint Compliance Coordinator
Insight Global
11.2012 - 06.2013
Senior Production Coordinator
Capital One Auto Finance
04.2009 - 05.2013
Inventory Clerk
Kelly Services
12.2008 - 02.2009
Bachelor of Science - Healthcare Management, Health Informatic
Colorado Technical University
Medical Assistant Diploma - Anatomy, Invoices, Front/Back Office
Remington College