Renee Pettiford
Kokomo
Summary
Experienced denial management specialist with strong track record in healthcare claims processing and resolution. Skilled in analyzing and addressing claim denials, ensuring compliance with industry regulations, and optimizing reimbursement processes. Known for effective team collaboration, adaptability to changing needs, and results-driven approach. Proficient in utilizing medical coding systems, insurance protocols, and data analysis tools.
Overview
13
13
years of professional experience
Work History
Claims Data Analyst
Cornerstone Financial Group
Philadelphia, PA
10.2021 - Current
- Expedited claims resolutions for improved customer satisfaction through thorough investigations and timely communications.
- Managed high-volume caseloads for optimal productivity while maintaining strict attention to detail.
- Developed a comprehensive understanding of ICD-10-CM, CPT, and HCPCS codes to ensure proper use in medical coding assignments.
- Managed a portfolio of key accounts, ensuring all claims data analysis needs were met in a timely and accurate fashion.
Denial Analyst
Humana
Houston, TX
12.2015 - 01.2021
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Expedited claims resolution by effectively collaborating with providers and payers to obtain necessary documentation or missing information..
- Played a key role in improving the organization's overall financial performance, minimizing lost revenue due to denied claims.
Medical Claims Examiner
Kaiser Permanente
San Francisco, CA
01.2013 - 11.2015
- Enhanced claim processing efficiency by conducting thorough investigations and maintaining accurate documentation.
- Supported team members during periods of high workload, providing guidance on challenging cases or offering assistance when needed
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Improved claim processing efficiency by implementing new medical claims examination practices and procedures.
- Handled complex claim issues, effectively communicating with patients, providers, and insurance companies to ensure resolution.
Education
High School Diploma -
Taylor High School
Kokomo, IN06-2010
Skills
- HIPAA compliance
- Claims processing
- Adaptive learning
- Data validationMedical Billing Software
- HCPCS coding
- Microsoft Excel
- Denial Management
- Call Center Experience
- Claims Analysis
Timeline
Claims Data Analyst
Cornerstone Financial Group
10.2021 - Current
Denial Analyst
Humana
12.2015 - 01.2021
Medical Claims Examiner
Kaiser Permanente
01.2013 - 11.2015
High School Diploma -
Taylor High School