Niki D. Frank
Amelia
Summary
Detail-oriented healthcare reimbursement specialist with over 12 years of experience in analyzing underpayment issues and ensuring compliance. Expertise in reviewing carrier contracts and facilitating appeals to enhance payment accuracy. Proven track record of improving financial performance through meticulous oversight and collaborative problem-solving.
Overview
19
19
years of professional experience
Work History
Managed Care Appeals Analyst
Elevate PFS
Cincinnati
11.2025 - Current
- Assists entire Common Spirit team with pricing and contract interpretation
- Assists Common Spirit Supervisor and Regional V.P. in account analysis and multiple special projects.
- Ensure provider payments, patient responsibility, sequestration and adjustments are correct in Validate and match the client system
- Analyze provider systems for insurance verification, payments and claim status.
- Ensure correct reimbursement by reviewing carrier contracts and claim payment details.
- Submit and write appeals to carriers to reprocess claims for underpayments and denials.
Underpayment Analyst
Revecore
Cincinnati
09.2017 - 11.2025
- Identify and recover underpayments due to incorrect coding, downcoding, contract discrepancies, and other errors.
- Reviewed carrier contracts and claim payment details to ensure accurate reimbursement.
- Coordinated with carriers to process appeals and reconsiderations, securing accurate payments.
- Analyze provider systems for insurance verification and claim status.
- Facilitated mid-month and month-end reporting processes, including payment reports and peer account reviews.
- Achieved top producer status consistently from 2018 to 2025 (20182025).
- Finalized completion of management training program designed for leadership development
Financial Counselor/Patient Accounting
TriHealth Inc.
Cincinnati
10.2015 - 07.2017
- Assisted patients with financial assistance programs, evaluating eligibility for discounts and government support to maximize access to care.
- Conducted bedside and in-office consultations to set up payment plans and explain benefits.
- Collected payments and provided price quotes while addressing billing inquiries to ensure clarity and satisfaction.
Patient Accounting Representative
TriHealth Inc.
Cincinnati
07.2014 - 10.2015
- Identified claim coding and underpayment errors, initiated corrections to recover owed funds.
- Conducted detailed claim reviews to ensure accurate patient billing.
- Processed patient billing inquiries efficiently and accurately.
- Reviewed insurance claims for compliance with policy guidelines.
- Coordinated payment plans with patients to ensure financial clarity.
Registration and Eligibility
Commonwealth Orthopedics/Ortho Cincy
Cincinnati
07.2013 - 06.2014
- Coordinated patient registration, verified insurance, and gathered medical history to ensure accurate patient records.
- Assisted in rooming patients and obtaining vitals to support efficient patient flow and care.
- Completed day-to-day duties accurately and efficiently.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
Customer Service Representative (Level 2) Hospital Team
Humana
10.2007 - 10.2011
- Supported members and providers with medical and prescription benefits, quotes, and claims resolution to ensure accurate information delivery.
- Managed high volume of inbound/outbound calls, resolving coverage and payment issues to enhance customer satisfaction.
- Provided customer support through phone and online channels.
- Resolved customer inquiries and concerns with empathy and professionalism.
- Documented customer interactions in the internal database accurately.
Education
Nursing Coursework
Cincinnati State Technical & Community College
Cincinnati, OH01-2014
High School Diploma -
Archbishop McNicholas High School
Cincinnati, OHSkills
- Claims appeals and reconsiderations
- Claims management
- Healthcare contract review
- Patient financial counseling
- Financial reconciliation
- Data analysis and issue resolution
- Meditech, Epic, Cerner, Soarian, Quadax, Soarian Star, Paragon, Availity, and Navinet
- Microsoft Office applications
- Customer service and communication
Timeline
Managed Care Appeals Analyst
Elevate PFS
11.2025 - Current
Underpayment Analyst
Revecore
09.2017 - 11.2025
Financial Counselor/Patient Accounting
TriHealth Inc.
10.2015 - 07.2017
Patient Accounting Representative
TriHealth Inc.
07.2014 - 10.2015
Registration and Eligibility
Commonwealth Orthopedics/Ortho Cincy
07.2013 - 06.2014
Customer Service Representative (Level 2) Hospital Team
Humana
10.2007 - 10.2011
Nursing Coursework
Cincinnati State Technical & Community College
High School Diploma -
Archbishop McNicholas High School