Summary
Overview
Work History
Education
Skills
Timeline
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Misty McDaniel

Revenue Cycle Specialist
Griffin

Summary

Highly organized and innovative healthcare professional with over 14 years of experience in providing optimal support, maintaining confidentiality, and building strong relationships. Skilled in audits and meeting deadlines independently, with a strong desire to continuously learn and improve. Proven ability to analyze data and implement effective process improvement initiatives. Experienced in managing multiple concurrent projects, adjudicating claims, ensuring regulatory compliance, and conducting complex issue research and analysis. Adept at providing training to new hires and proficient in reporting data, problem-solving, and strategic planning. Capable of developing attributes that outline health outcomes, meet customer needs, and enhance organizational performance.

Overview

6
6
years of professional experience

Work History

Revenue Cycle Claims Specialist

Natera, Inc
07.2023 - Current
  • Researched claims processing guidelines, provider contracts, fee schedules, and system configurations to determine the root cause of payment errors
  • Developed and maintained positive customer relations with internal and external customers and coordinated with various functions within the company to ensure problems, requests, and questions were resolved
  • Managed and processed large datasets to submit corrected claims, appeals, reconsiderations, and write-offs
  • Provided input to management on process improvement and regarding current inventory issues for inquiry analysis
  • Remote

Grievance and Appeals Representative III

Humana, Inc
10.2021 - 07.2023
  • Managed documentation by collecting records (medical, claims, administrative) needed to research the appeal or complaint request from both internal and external customers
  • Collaborated with other departments to gather information required to resolve resolutions of the appeal or complaint presented
  • Gathered, analyzed, and reported verbal and written complaints, grievances, and appeals
  • Conducted and handled prior authorizations and retrospectives to ensure compliance and quality-related goals were met
  • Remote

Financial Specialist

Shands at the University of Florida
03.2019 - 10.2021
  • Navigated through multiple computerized systems to track, gather information, and troubleshoot the systems as needed
  • Assisted with supporting members with locating local healthcare providers and resolving claim concerns
  • Collaborated with staff auditors to ensure each call and procedure was followed per company and department guidelines
  • Examined and aided in managing contracts and explanation of individual healthcare plans
  • Managed verification of insurance and obtaining prior authorization for services
  • Hybrid

Education

Bachelor’s - Criminal Justice

Columbus State University
Columbus, GA

High School Diploma - undefined

Jordan Vocational High School
01.2002

AAPC medical coding online courses - Medical Coding

AAPC
07-2025

Skills

  • Project Management
  • Time Management
  • Data Analysis
  • Verbal and Written Communication
  • Quality Improvement
  • Process Optimization
  • Conflict Resolution
  • Strategic initiatives
  • Interpersonal Skills
  • Negotiation
  • Managed Care
  • Decision-Making Skills
  • Microsoft Office (Excel, Word)
  • Epic and AMD

Timeline

Revenue Cycle Claims Specialist

Natera, Inc
07.2023 - Current

Grievance and Appeals Representative III

Humana, Inc
10.2021 - 07.2023

Financial Specialist

Shands at the University of Florida
03.2019 - 10.2021

High School Diploma - undefined

Jordan Vocational High School

Bachelor’s - Criminal Justice

Columbus State University

AAPC medical coding online courses - Medical Coding

AAPC

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