Renita Pennington
Chapel Hill,NC
Summary
Expert in implementing software solutions to streamline operations, enhance precision, and meet compliance requirements. Solid background in maintaining data accuracy and processing efficiency. Strong organizational capabilities support high-quality data management. History of dependability and flexibility in fast-paced workplaces.
Overview
6
6
years of professional experience
Work History
Managed Care Consultant
North Carolina Department of Heath and Human Services
01.2024 - Current
- Executed assignments supporting NC Medicaid Managed Care operations across multiple programs, including PIHP Medicaid Direct.
- Achieved prompt completion of assigned monitoring tasks by following clear instructions.
- Engaged with cross-functional teams in Provider Ops and other divisions to ensure readiness for MC launch.
- Represented MC program interests in meetings, remaining updated on developments for ongoing and future managed care initiatives.
Claims Specialist
Night and Day Dental
03.2022 - 01.2024
- Processed claims over 30 days past due through EagleSoft and Ascend systems.
- Contacted insurance companies to determine next steps for closing claims.
- Communicated with insurance companies to clarify benefits and limitations of dental plans.
- Posted payments to patient accounts and reconciled dental office ledgers.
Claims Specialist
MetLife
05.2019 - 03.2022
- Approved routine claims that could not be auto adjudicated through thorough analysis.
- Conducted eligibility verification and applied dental necessity guidelines for accurate coverage decisions.
- Proactively identified discrepancies while implementing cost containment strategies during claim adjudication.
- Prepared clinical narratives, treatment notes, and attachments for appeal processes.
Education
High School Diploma - undefined
Northern
Durham, NC06.2008
Skills
- Knowledge of HIPAA guidelines
- Microsoft Office applications
- Familiarity with insurance terminology
- Claims management
- Data entry software skills
- Insurance plan verification processes
- Prior authorization handling
Timeline
Managed Care Consultant
North Carolina Department of Heath and Human Services
01.2024 - Current
Claims Specialist
Night and Day Dental
03.2022 - 01.2024
Claims Specialist
MetLife
05.2019 - 03.2022
High School Diploma - undefined
Northern
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