Nakini Mumpfield
Montgomery,AL
Summary
Meticulous Denial Specialist offering 2-year track record conducting prompt, thorough investigations of health insurance claims. Well-versed in establishing proof of loss by studying medical documents, assembling additional information from outside sources and initiating and conducting investigations of questionable claims. Responsible and mature individual possessing sound decision-making and interpersonal skills.
Overview
8
8
years of professional experience
Work History
Denial Specialist
Cigna Insurance Companies-Remote
10.2022 - Current
- Responsible for working with insurance companies to perform denial resolution on outstanding claims
- Reviews denied claims to determine appropriate course of action Interacts with payers to determine true reason for denial and inquire on what corrections need to be made
- Work with the coding team when necessary to make coding changes to submit corrected claims or appeals
- Create a case for the appeal stating the deficiencies and the resolution
- Take ownership for the quality and timeliness of work and achieves the desired results
- Stay current with payer trends for submitting corrected claims and appeals
- Maintain strict confidentiality regarding Patient Health Information (PHI) as well as follows HIPAA regulations
- Identify billing trends (i.e
- Claim format, denials, and payment issues)
- Other duties as assigned
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Identified root cause of denials to provide plans for denial resolution.
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Maintained up-to-date knowledge of industry trends and best practices in denial management, ensuring the organization's processes remained competitive and effective.
Customer Service Representative/Quality Assurance/ Underwriting
American Express-Remote
07.2021 - Current
- Assisted customers with a warm and professional attitude
- Assisted customers with questions
- Interacted with customers through live chat
- Kept records of customer complaints
- Handled emails, inbound calls, and outbound calls
- Managed customer accounts
- Assisted with technical support duties.
- Managed approximately 70 incoming calls and emails per day.
Universal Banker II
Truist Financial-Atlanta, GA
08.2019 - 01.2021
- Quickly answer customer inquiries in a friendly and courteous manner, deliver exceptional service to our customer by going out of the way to please them, provide first call resolution, while following strict procedures that meet compliance guidelines, identify and offer customers the products and services they need and want to succeed financially.
- Improved customer satisfaction by providing personalized banking solutions and addressing client needs promptly.
- Managed escalated phone calls by applying conflict resolutions skills and extensive knowledge of bank policies, products, and services.
- Conducted thorough customer assessments to identify opportunities for upselling or targeting specific financial goals.
Phone Banker
Wells Fargo-Birmingham, AL
07.2016 - 07.2019
- Quickly answer customer inquiries in a friendly and courteous manner, deliver exceptional service to our customer by going out of the way to please them, provide first call resolution, while following strict procedures that meet compliance guidelines, identify and offer customers the products and services they need and want to succeed financially.
Education
High School Diploma -
Carver Sr. High
Montgomery, AL05.2004
Skills
- 70 wpm
- Process implementation
- Banking
- Human Resources
- HRIS
- Eligibility Determination
- Appeals processing
- ICD-10 Proficiency
- HIPAA Compliance
- Claims analysis
- Insurance Verification
- Denial Management
- Documentation Review
- Provider Relations
- Medicare Regulations
- Medical Billing
- Claim Adjustment
Personal Information
Title: Denial Specialist
Timeline
Denial Specialist
Cigna Insurance Companies-Remote
10.2022 - Current
Customer Service Representative/Quality Assurance/ Underwriting
American Express-Remote
07.2021 - Current
Universal Banker II
Truist Financial-Atlanta, GA
08.2019 - 01.2021
Phone Banker
Wells Fargo-Birmingham, AL
07.2016 - 07.2019
High School Diploma -
Carver Sr. High
Similar Profiles
Tiffany KirkendollTiffany Kirkendoll
Grievance and CTM Customer Service Team Lead at Cigna Insurance CompaniesGrievance and CTM Customer Service Team Lead at Cigna Insurance Companies
Khadijah MyersKhadijah Myers
Customer Service Representative at Cigna Insurance CompaniesCustomer Service Representative at Cigna Insurance Companies
Erica NelsonErica Nelson
Customer Service Advocate at Cigna Insurance CompaniesCustomer Service Advocate at Cigna Insurance Companies
Jasmine ColeJasmine Cole
Restaurant Hostess at BB King'sRestaurant Hostess at BB King's
Kembria GilbertKembria Gilbert
Registered Nurse, Med/Surg Onc at Jackson HospitalRegistered Nurse, Med/Surg Onc at Jackson Hospital