Nidra Purnell
Dover,DE
Overview
17
17
years of professional experience
Work History
CSR
Dane Street
Dover, Delaware
05.2024 - Current
- Work with a client to resolve missing information needed for claim processing and case setup.
- Monitored case progress, assigned new cases to physicians based on location, availability, guidelines, jurisdiction, and client requirements, and confirmed no conflict of interest.
- Managed oversight of case assignments and progress to ensure compliance with guidelines.
- Handled assignment of cases to ensure efficient workflow and adherence to client needs.
- Assign/schedule new cases to physicians for review with the appropriate physician, based on location, reviewer availability, specific guidelines, jurisdictional requirements and other client requirements.
- Ensure that the assigned physician has no conflict of interest with the case assignment.
- Facilitated client interactions to ensure open communication and timely resolution of inquiries.
- Ensure that the assigned physician has no conflict of interest with the case assignment
- Receive new cases, enter intake details into the Dane Street system AccessDS, and review request information for accuracy.
- Sorted, organized, and created medical document listings as required by client and special handling guidelines to support case processing.
Claim Negotiator
Multiplan
Dover, Delaware
10.2021 - 12.2024
- Reviewed claim records to identify and capitalize on savings opportunities.
- Facilitated provider agreement negotiations, ensuring compliance with client guidelines and alignment with department goals.
- Collaborated with providers and facility representatives to negotiate and resolve healthcare reimbursement terms.
- Reviewed claim data to uncover potential cost savings.
- Worked with providers and facility representatives to resolve healthcare reimbursement terms.
- Identified opportunities for cost savings through detailed claim reviews.
- Maintained alignment of provider agreements with established client guidelines and department goals.
- Executed healthcare claims processing while adhering to applicable laws and client deadlines.
- Established healthcare reimbursement terms in collaboration with providers and facility representatives.
Billing/Insurance Specialist
My Eye Dr
Dover, Delaware
05.2009 - 10.2021
- Reviewed and updated patient insurance details to maintain compliance and streamline billing processes.
- Assisted customers with scheduling and billing questions, enhancing overall customer satisfaction.
- Processed accounts receivable and payable transactions to ensure accurate financial records.
- Entered patient data while following HIPAA guidelines.
- Drafted and revised documents for accuracy and clarity.
- Performed various clerical tasks to support daily office functions. to support office operations.
Engagement Specialist
Capital One
Dover, Delaware
05.2013 - 05.2016
- Retained customers by quickly and professionally resolving account issues.
- Resolved complex account concerns, ensuring 98% accuracy in customer account records.
- Delivered courteous customer support while maintaining strong interaction standards.
- Explained account the account upgrade benefits to improve service value and customer satisfaction.
- Provided detailed information on account upgrade choices to enhance service value.
Education
High School Diploma -
Excel High School
Orlando, FL01-2012
Skills
- Claims processing
- Healthcare claims
- Case intake
- Medical document review
- Utilization review
- Insurance verification
- AccessDS database
- Claims negotiation
- Regulatory compliance
- Case management
- Stakeholder engagement
- Attention to detail
Timeline
CSR
Dane Street
05.2024 - Current
Claim Negotiator
Multiplan
10.2021 - 12.2024
Engagement Specialist
Capital One
05.2013 - 05.2016
Billing/Insurance Specialist
My Eye Dr
05.2009 - 10.2021
High School Diploma -
Excel High School