Summary
Overview
Work History
Education
Skills
Timeline
Generic

Nancy Daniel

Tyler,Texas

Summary

Claims professional well-versed in intricacies of claim management and resolution. Known for strategic approach to resolving disputes and ensuring compliance with industry standards. Reliable team collaborator with focus on achieving optimal outcomes and adapting to changing requirements. Skilled in negotiation and critical thinking.

Overview

30
30
years of professional experience

Work History

Claims Specialist

Heaton Eye Associates
Tyler, TX
05.2023 - Current
  • Evaluated insurance claims for accuracy and compliance with company policies.
  • Processed high-volume claims efficiently while maintaining meticulous attention to detail.
  • Collaborated with cross-functional teams to resolve complex claim issues promptly.
  • Trained new staff on claims processing procedures and best practices.
  • Implemented process improvements that enhanced workflow efficiency in claims handling.
  • Led initiatives to streamline claims review processes, reducing turnaround times significantly.

Medical Claims Analyst

Baylor Scott & White Texas Spine & Joint Hospital
Tyler, TX
09.2019 - 03.2022

Work with private, commerical and federal insurance companies to resolve status of submitted claims for payment. Work denial claims for payment. Collection on bad debt accounts.

Medical Claims Analyst

Physicians Auditing & Billing Services, Inc.
Greenville, Texas
10.2011 - 09.2019

Work with private, commercial and federal insurance companies to resolve status of submitted claims for payment. Work denial claims for payment. Collection on bad debt accounts.

Medical Records Custodian Assistant

East Texas Medical Center
TX
02.2009 - 10.2011
  • Duties included working with private insurance carriers, Medicare and Medicaid to resolve status of submitted claims for payment.
  • Posting and/or refunding payments to patient accounts.
  • Resolve any issues with patients in regards to their accounts and setup payment plans.
  • Translating and working with Spanish speaking only patients whenever needed., Data entry for all medical records request from attorneys, insurance companies and doctors offices.
  • Scheduling and cancellations for patients.
  • Fill in for other departments when someone is out.
  • Filing and pulling charts.
  • Over medical records personnel when supervisor is out.

Collections Account Representative

Cardiovascular Consultants
TX
04.2006 - 02.2009
  • Duties include working with private insurance carriers, Medicare and Medicaid to resolve status of submitted claims for payment.
  • Posting and/or refunding payments to patient accounts.
  • Resolve any issues with patients in regards to their accounts and setup payment plans.
  • Translating and working with Spanish speaking only patients whenever needed.

Account Representative/Medical Records Custodian Assistant Account Representative

Trinity Clinic
TX
11.2002 - 03.2006
  • Worked one on one with patients to make payment arrangements to bring past due accounts current or settle old accounts.
  • Worked with insurance carriers to submit claims with proper ICD-9 codes for payment, resubmitted claims that were denied for various reasons with correct information for payment.
  • Handled fifty accounts or more in one day.
  • Answering phones and routing calls, scheduling and registering patients, insurance verification.
  • Able to multi-task and be an independent worker.

Customer Service Representative

Stage
Jacksonville, TX
01.1996 - 06.1998

Credit card collections for all Stage, Palais Royal and Beall's in English and Spanish accounts.

Education

Associate of Science - Nurse Assistant

Bish Mathis Institute
Tyler, TX
1992

John Tyler High School
Tyler, TX
05.1990

Skills

  • Claims processing
  • Computer literate
  • Data entry
  • Filing
  • ICD-9
  • Insurance
  • Medical terminology
  • Answering phones
  • Recordkeeping organization

Timeline

Claims Specialist

Heaton Eye Associates
05.2023 - Current

Medical Claims Analyst

Baylor Scott & White Texas Spine & Joint Hospital
09.2019 - 03.2022

Medical Claims Analyst

Physicians Auditing & Billing Services, Inc.
10.2011 - 09.2019

Medical Records Custodian Assistant

East Texas Medical Center
02.2009 - 10.2011

Collections Account Representative

Cardiovascular Consultants
04.2006 - 02.2009

Account Representative/Medical Records Custodian Assistant Account Representative

Trinity Clinic
11.2002 - 03.2006

Customer Service Representative

Stage
01.1996 - 06.1998

John Tyler High School

Associate of Science - Nurse Assistant

Bish Mathis Institute
Nancy Daniel