Stacey Newkirk
Grass Valley,CA
Summary
Accomplished Provider Dispute Resolution Specialist at Nivano Physicians, adept in alternative dispute resolution and maintaining confidentiality. Excelled in driving effective problem-solving and negotiation, surpassing daily goals with exceptional reliability. Expert in Professional (HCFA 1500) and Institutional (UB04) claims, consistently exceeding production and quality standards.
Responsible Senior Claims Examiner with deep knowledge of Medical claims industry. Solid abilities in developing objectives and strategies to settle claims. Excellent skills compiling, coding, categorizing and auditing information to process claims.
Training/ Mentorship/ Team Management
Overview
21
21
years of professional experience
Work History
Provider Dispute Resolution Specialist
Nivano Physicians
01.2022 - Current
- Maintained strict adherence to ethical guidelines and industry best practices, upholding the highest standards of professionalism and integrity in all aspects of dispute resolution work.
- Resolved disputes by expertly analyzing cases and implementing effective negotiation strategies.
- Drove dispute resolutions using effective problem-solving and by guiding mutual understanding of opposing viewpoints.
- Researched issue related to claims processing to identify origins and implement corrective solutions.
- Met and exceeded daily goals.
- Excellent work ethic
- Worked and maintained outstanding attendance record.
Claims Team Leader
Nivano Physicians
09.2019 - 12.2021
- Managed high volume of claims while maintaining strict adherence to company policies and industry regulations.
- Training and Auditing new Examiners
- Up training existing Examiners in Professional and Institutional claims (HCFA 500/UB04)
- Help process PDR's and Customer Service incident claims and projects.
- leadership claims research for Provider relations and issues
- Developed strong relationships with external partners, facilitating seamless coordination on complex claims issues.
- Created and implemented training and production goal tracking for claim ramp up.
- Managing and distributing workload
- Helped streamline all process improvements for a more efficient workflow.
- Ensuring that the claims examiners are meeting standards set by our policy procedures and compliance guidelines.
Claims Examiner
Nivano Physicians
01.2004 - 08.2019
- Data entry
- Evaluated accuracy and quality of data entered into the system
- Paid and denied medical claims based upon established claims processing criteria
- Reviewed provider coding information to report services and verify correctness
- Used administrative guidelines as resource or to answer questions when processing medical claims
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Maintained confidentiality of patient finances, records and health statuses.
- Maintained excellent attendance record, consistently arriving to work on time.
- ( SME) Subject Matter Expert
- Researched complex claims for completion and payment.
- Was assigned and worked various special projects for all management staff in the claims department
- Researched complex claims for completion and payment.
- Can work to completion IP professional, institutional, Home Infusion, Home Health and continually receive training to further my knowledge.
- Regularly met and exceeded production and quality standards.
Education
High School Diploma -
Nevada Union High School
Grass Valley, CASkills
Maintaining confidentiality
Alternative dispute resolution
Dispute Analysis
Teamwork and Collaboration
Problem-Solving
Time Management
Attention to Detail
Multitasking
Reliability
Data Entry
Timeline
Provider Dispute Resolution Specialist
Nivano Physicians
01.2022 - Current
Claims Team Leader
Nivano Physicians
09.2019 - 12.2021
Claims Examiner
Nivano Physicians
01.2004 - 08.2019
High School Diploma -
Nevada Union High School
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