PIERCE WARNER
Winder,US
Summary
Meticulous Denial Specialist offering 3+ 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. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level trade based position. Ready to help team achieve company goals.
Overview
5
5
years of professional experience
Work History
Denial Specialist
Agility Billing
12.2020 - Current
- Documented medical claim actions by completing forms, reports, logs and records.
- Resolved medical claims by approving or denying documentation, calculating benefit due and initiating payment or composing denial letter.
- Adjusted client accounts by entering discretionary billing items, requesting rebills and updating billing entity records.
- Conducted in-depth analysis of inquiries and complaints to compose appeal letters for clients.
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Examined medical treatment records and medical bills to gauge overall extent of liability.
- Contacted clients to collect information and communicate disposition of case, documenting interactions regarding eligibility, verification of benefits and claims payment status.
- Identified root cause of denials to provide plans for denial resolution.
- Generated, posted and attached information to claim files.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified client information by analyzing existing evidence on file.
- Calculated adjustments, premiums and refunds.
- Processed and recorded new policies and claims.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Coordinated with contracting department to resolve payer issues.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Audited and corrected billing and posting documents for accuracy.
Molecular
Adaptive Health Integrations
12.2020 - Current
- Addressed issues with on going processes or future problems that will arise with the Covid program
- Collaborated with other employees, Managers, and Directors to create more efficient strategies when working through covid accounts
- Aided In the creation of HRSA related training and SOPs
- Trained part time employees, new hires, and management on covid related projects
- Had an excellent attendance record and was always on time for work
- Developed efficient communication when problems or challenges arrived
- Transferred between departments to use prior knowledge in aiding Denials and Rejects
- Consistently score high audits and reviews
- Shown eagerness to learn and develop new skills
- Learned to follow up on time sensitive accounts in a timely matter
- Knowing when to prioritize projects over others in regards to importance and sensitivity
- Has consistently had one of the highest efficiency/ productivity rates
- Undertaken a multitude of projects and have shown the ability to complete all of them regardless of overlap
- Willingness to work overtime to complete work that is urgent to the company
- Shown the willingness to learn, teach, and grow alongside fellow employees and the company
- Adaptive to change
- Driven to improve not only my own work, but to help improve the recourses and knowledge of others.
- Documented and verified patient information using laboratory information system.
- Analyzed and interpreted data, accurately identifying and reporting laboratory results.
- Helped management optimize laboratory processes for maximum efficiency and performance.
Restaurant Supervisor
Arditi Pizzeria
08.2019 - 12.2020
- Appointed work to other members of the wait staff and back of house workers
- Created new menu items that were financially and customer driven
- This entails creating items that are new, seasonal, and ensuring that the margin of profit is viable
- Helping in creating social media posts to increase business during high competitive markets
- Aided in running the front of house and kitchen
- This included cooking meals for guests while ensuring they are receiving optimal care from the other staff members
- Remaining attentive to team members schedules and needs
- This not only included what hours an employee would work, but also any updates to training that were required
- Ensuring that employees were aware of all tasks that were required of them
- Training would be implemented by myself when required regardless of position
- Communication between the needs and wants of customers to the restaurant’s owners
- Increased service levels through hands-on leadership
- Followed all food safety guidelines and regulations
- Added efficiency to the back of house to make sure that the staff would not have unnecessary struggles or hardship
- Identified, investigated, and corrected operational issues such as inventory waste and theft to keep the business running at its best
- Improved my own work through experiences
- Started as a dish washer and ended by supervising all aspects of the restaurant
- Established good customer relations and excellent service to build and retain loyal customers.
- Boosted customer satisfaction and service delivery to strengthen customer loyalty.
- Supervised staff to confirm that all food and beverage orders were promptly and accurately prepared.
- Coordinated with kitchen employees and front of house personnel to consistently drive smooth operations.
- Monitored staff performance, enforcing adherence to policies, procedures, regulations, health codes, license requirements and top service standards.
- Hired, trained and mentored staff to meet and exceed high quality standards.
- Directed both FOH and BOH employees through daily tasks and monitored performance throughout day.
- Maintained accurate records of sales, labor and other costs.
- Monitored staff performance, enforcing adherence to policies, procedures, regulations, health codes, license requirements, and top service standards.
- Conducted weekly and monthly staff meetings to review performance and discuss upcoming events.
- Organized implementation of new banners, displays and menus.
- Addressed customer complaints with professional demeanor and used communication and problem-solving skills to resolve issues.
- Trained new hires in food handling and safety protocols to boost knowledge and performance.
- Scheduled and rotated staff for adequate coverage and fair distribution of workload.
Overnight Stocker and Receiver
Kroger
06.2018 - 09.2018
- Engaged customers and provided very high level of service and support, helping find desired products and items.
- Organized efficient merchandise replenishment strategies to keep shelves stocked and well-organized for customers.
- Reviewed inventory levels and placed orders for products and merchandise for restocking purposes.
- Delegated tasks and duties to grocery staff and clearly communicated timeframes for completion.
- Performed key tasks to promote inviting grocery store appearance.
- Adhered to safety processes and procedures when stocking store to avoid falls and other injuries.
- Unloaded pallets and deliveries and organized products in warehouse.
- Monitored and managed stock levels of goods to verify availability of products.
- Double-checked cargo inventories and documentation for accuracy.
- Utilized forklift to transport pallets of goods to and from warehouse.
Education
High School Diploma -
Brookwood High School
Snellville, GA2018
Skills
- Conflict Resolution Techniques
- Staff Development Talent
- Labor and Food Cost Control
- Hiring and Training
- Complaint Resolution
- Performance Improvement
- Training and Development
- Organization and Prioritization
- Staff Supervision
Accomplishments
- I have started from base data entry and have shown that I remain eager to improve, learn, and thrive
- As the sole HRSA specialist, I can say that I am proud how much I haveimproved in a short period of time and I have no intention on stopping
- Communicative
- Resourceful
- Eagerness to Learn
- Team building
- Problem resolution
- Organization
- Process improvement
- Relationship development
- Customer service
- Team management
Professional Contacts
Brett Bennet 770-377-8778
Christine Chapman 706-983-0543
Ryan Capone 770-298-0577
Patrick Wade 678-614-2639
Angie Smith 770-289-0895
Timeline
Denial Specialist
Agility Billing
12.2020 - Current
Molecular
Adaptive Health Integrations
12.2020 - Current
Restaurant Supervisor
Arditi Pizzeria
08.2019 - 12.2020
Overnight Stocker and Receiver
Kroger
06.2018 - 09.2018
High School Diploma -
Brookwood High School
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