When I'm Not Adjudicating Claims: You can find me at the intersection of "Indoorsy" and "Outdoorsy" I'm either optimizing my PC software for peak gaming performance, getting lost in anime lore, or recharging on a cruise ship I'm a fan of loud concerts , quiet nature hikes, and any challenge that requires a bit of technical tinkering
Mariah Corley
Martinez,GA
Summary
The Hybrid Specialist. I bridge the gap between high-stakes healthcare finance, legal eDiscovery, and advanced data intelligence. With a mastery of the Full-Cycle RCM and a tech stack ranging from QNXT and Salesforce to DISCO and Power BI , I don't just manage workflows I protect the bottom line. Whether I am architecting DMEPOS billing strategies , navigating CMS/OIG compliance , or synthesizing raw data into actionable insights via Tableau , I transform fragmented administrative processes into streamlined, audit-ready revenue engines. I am a results-driven problem solver focused on Revenue Integrity , data transparency, and operational excellence.
Overview
9
9
years of professional experience
Work History
DME Specialist
GuideWell
Remote
11.2024 - 02.2026
- Served as primary liaison between providers and patients to coordinate DME requests while maintaining CMS, Medicare, and Medicaid policy compliance.
- Completed insurance verification and managed complex prior authorizations to support on-time equipment delivery and accurate reimbursement.
- Partnered with clinical and provider teams to resolve documentation gaps and prevent billing delays and denials.
- Facilitated the medical necessity review process by synthesizing clinical data and plan benefits, ensuring that complex DME authorizations met both NCQA standards and specialized payer guidelines to minimize financial liability
Data Entry Specialist
UnitedHealthcare
Remote
08.2023 - 10.2024
- Entered and validated high-volume, sensitive healthcare data with strong accuracy and confidentiality standards (HIPAA-aware handling).
- Maintained organized records and performed quality checks to reduce rework and downstream claim processing issues.
- Prioritized workload to meet tight deadlines in a fast-paced, remote production environment.
- Remote
Customer Service Representative- Temp
Faneuil (L.A. Care)
Remote
12.2022 - 01.2024
- Supported members with Medicare/Medicaid enrollment and service navigation, including transportation coordination and access to care.
- Used QNXT to review member information, track claim-related activity, and document interactions accurately.
- Delivered tailored, empathetic support using persuasive communication and de-escalation to improve member outcomes.
- Processed claims and managed account updates with attention to detail.
Technical Support Specialist - Temp
Apple
Remote
02.2021 - 12.2022
- Resolved hardware/software issues and guided users through setup and troubleshooting.
- Documented resolutions and managed high-volume queues with consistent service quality.
- Educated users on the Apple Ecosystem and iCloud integration, empowering customers to maximize device synergy across iOS, macOS, and watchOS while proactively preventing data loss.
- Delivered personalized technical consultations using the "Apple Steps of Service," translating complex diagnostic data into relatable solutions while maintaining high CSAT (Customer Satisfaction) and NPS (Net Promoter) scores.
Claim Support Supervisor
Teleperformance
Hybrid
12.2016 - 02.2021
- Supervised a team that processes and adjudicates healthcare claims in QNXT, ensuring quality, accuracy, and compliance.
- Coached agents, monitored performance, and addressed workflow issues to meet client standards and productivity targets.
- Reviewed metrics and trends to improve processes and reduce errors impacting claim outcomes and payments.
- Audit-proofed operations by conducting root cause analyses of complex claim denials and payment variances and implementing corrective action plans aligned with HIPAA regulations and SLA requirements.
Education
Master of Science - Cyber Security Technology
Strayer University
09-2026
Bachelor of Science - Criminal Justice
Strayer University
09-2023
High School Diploma - undefined
Glenn Hills High School
05-2014
Skills
- Medical Billing & Claims Lifecycle: Expert management of end-to-end billing to ensure maximum, timely reimbursement
- A/R Management & Analysis: Strategic oversight of aging reports and collections to consistently reduce days in A/R
- HCPCS Coding & DME Documentation: Specialized proficiency in Durable Medical Equipment coding and clinical necessity alignment
- Authorization Lifecycle Management: Directing medical necessity reviews and pre-certification workflows to prevent denials
- Regulatory Adherence: Expert application of CMS, Medicare, and Medicaid guidelines to maintain strict payer compliance
- eDiscovery & Litigation Support: Proficient in DISCO and Relativity for large-scale legal data review and internal investigations
Revenue Cycle & Claims Optimization
Compliance, Legal & Provider Relations
- PECOS Provider Enrollment: Managing government portals for official provider credentialing and program enrollment
- Clinical & Provider Coordination: Acting as a high-level liaison between medical staff, insurers, and legal teams
- Healthcare Systems: Advanced proficiency in QNXT (Claims Adjudication), APEX (Clearinghouse), and Citrix environments
- CRM & ERP Platforms: Expert user of Salesforce, HubSpot, and Workday for enterprise-level resource management
- Data Analytics & Visualization: Developing actionable business insights using Microsoft Power BI and Tableau
- Productivity & Quality Control: Advanced Microsoft 365 and Agile methodologies with a focus on high-fidelity data integrity
Software & Technical Ecosystem
Accomplishments
- 3 Standout Accomplishments
- REVENUE: Recovered $250K+ in annual revenue by leveraging Power BI to identify and eliminate systemic billing leakages.
- EFFICIENCY: Slashed A/R cycles by 20% through automated claim-scrubbing workflows and aggressive denial management in APEX .
- LITIGATION: Orchestrated the review of 500k+ documents in DISCO/Relativity , reducing legal processing costs by 30% via advanced data filtering.
Interests
Timeline
DME Specialist
GuideWell
11.2024 - 02.2026
Data Entry Specialist
UnitedHealthcare
08.2023 - 10.2024
Customer Service Representative- Temp
Faneuil (L.A. Care)
12.2022 - 01.2024
Technical Support Specialist - Temp
Apple
02.2021 - 12.2022
Claim Support Supervisor
Teleperformance
12.2016 - 02.2021
High School Diploma - undefined
Glenn Hills High School
Master of Science - Cyber Security Technology
Strayer University
Bachelor of Science - Criminal Justice
Strayer University