Maliyah Fagan
Acworth,Georgia
Summary
Accomplished Insurance Follow-Up Specialist at GetixHealth, adept in claims processing and denial management. Enhanced collections performance through strategic action plans and exceptional communication. Proven track record in boosting revenue recovery and streamlining workflows. Recognized for reliability and attention to detail, ensuring timely resolution of claims and fostering positive client relationships. Experienced denial management specialist with strong track record in healthcare claims processing and resolution. Skilled in analyzing and addressing claim denials, ensuring compliance with industry regulations, and optimizing reimbursement processes. Known for effective team collaboration, adaptability to changing needs, and results-driven approach. Proficient in utilizing medical coding systems, insurance protocols, and data analysis tools.
Overview
6
6
years of professional experience
Work History
Data Entry Specialist
Wipro
10.2020 - 11.2022
- Maintained strict confidentiality of sensitive information, adhering to established guidelines and protocols.
- Completed data entry tasks with accuracy and efficiency.
- Compiled data and reviewed information for accuracy prior to input.
- Contributed to team success by consistently meeting or exceeding performance targets in speed, accuracy, and output volume.
- Reduced errors in data records by conducting thorough quality checks and implementing corrective measures.
- Increased productivity through effective multitasking, prioritizing diverse workloads according to deadlines.
- Ensured timely and accurate delivery of reports by maintaining up-to-date databases and spreadsheets.
- Corrected data entry errors to prevent later issues such as duplication or data degradation.
Direct Support Professional
Georgia industrial children's home
12.2022 - 10.2024
- Facilitated social outings and community integration activities, promoting inclusion and positive experiences for clients.
- Maintained clean, safe, and well-organized patient environment.
- Monitored clients to assess and report physical and behavioral changes to supervisors.
- Improved client self-sufficiency through teaching essential skills such as meal preparation, housekeeping, and financial management.
- Assisted with crisis intervention to de-escalate challenging behavior and maintain peaceful encounters.
- Encouraged and supported clients to participate in recreational and leisure activities to promote social interactions and reduce loneliness.
Patient Account Representative
Conifer Health
10.2025 - Current
- Perform daily follow-up calls to insurance companies and commercial payors regarding outstanding claims.
- Utilize EPIC system to review patient accounts, submit claims, and document account activity.
- Work within DDE to check Medicare claim status, correct claim errors, and resubmit as needed.
- Prepare and submit appeals with supporting documentation for denied claims.
- Review accounts for medical necessity requirements and ensure proper documentation is included.
- Verify claim accuracy, coding, and modifiers prior to resubmission.
- Communicate with payer representatives to resolve billing issues and expedite payments.
- Maintain detailed notes on all account activities and payer communications.
- Ensure compliance with payer policies and billing regulations.
- Review and analyze EOBs to identify denial reasons, underpayments, and discrepancies.
- Medical denials including:
- Medical necessity denials
- Authorization/precertification denials
- Timely filing denials
- Bundling and coding denials
- Modifier-related denials
- Duplicate claim denials
- Non-covered service denials
- Eligibility denials
- Coordination of benefits (COB) denials
Education
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Mundy's Mill High School
Clayton, Ga05.2020
Skills
- Critical thinking capacity
- Organizational growth
- HIPAA compliance
- Effective communication
- Computer software proficiency
- Strong analytical skills
- Time management mastery
- Claims processing expertise
- Denial management strategies
- Medical terminology fluency
- Appeals process experience
- CPT coding proficiency
- Medical billing proficiency
- Medicare and medicaid expertise
- Teamwork and collaboration
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Multitasking Abilities
- Reliability
- Excellent communication
- Calm and professional under pressure
- Coding
- Medical terminology
Timeline
Patient Account Representative
Conifer Health
10.2025 - Current
Direct Support Professional
Georgia industrial children's home
12.2022 - 10.2024
Data Entry Specialist
Wipro
10.2020 - 11.2022
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Mundy's Mill High School