Terronda Daniel
Columbus,United States
Summary
Accomplished Human Resources Specialist and Medical Claims Analyst with a proven track record. Adept in medical billing & coding and exceptional in customer service. Expertise in claims processing and resolution, enhanced by meticulous attention to detail, led to a significant reduction in claim denials. Skilled in leveraging HIPAA compliance and data analysis to improve operational efficiency. Driven with expertise in promoting insurance options, determining clients' needs and detecting potential clients. In-depth knowledge of claims processing, database management and correspondence. Outstanding analytical, interpersonal and organizational skills. Dedicated to expediently resolving insurance issues and exceeding client expectations.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Human Resources Specialist
United States Army Reserve
12.2019 - Current
- Maintained personnel records and statistical data to establish accuracy and compliance with applicable regulations.
- Managed benefits administration for company-wide staff, ensuring timely processing and accurate recordkeeping.
- Conducted routine HR audits to ensure data accuracy in personnel files, payroll records, and benefit enrollments.
- Administered employee leave requests in accordance with FMLA guidelines, maintaining compliance with regulations while providing necessary accommodations for staff members.
- Facilitated smooth onboarding processes for new hires, leading to faster integration into workplace culture.
- Coordinated employee training programs to boost skills development and improve overall performance.
- Developed and maintained up-to-date database of employee records, ensuring compliance with legal requirements.
Medical Claims Analyst
Aspirion Health Resources
01.2020 - 08.2020
- Managed insurance claims for over 100 hospitals and healthcare providers, ensuring accurate coding for services, diagnoses, and treatments.
- Reviewed medical files, corrected coding errors, and processed claims to ensure compliance with insurance requirements.
- Handled appeals and denials by researching and resolving discrepancies in claims, leading to a reduction in denied claims.
- Processed medical billing for services rendered, ensuring timely invoicing and payment submission.
- Collaborated with insurance companies to address claim rejections, improve claim resolution processes, and ensure accurate payments.
- Delivered accurate invoicing and payment processing, significantly reducing claim delays.
- Assisted in the design and implementation of quality improvement initiatives, resulting in a more streamlined member experience.
- Maintained up-to-date knowledge of government programs such as Medicare and Medicaid, enabling accurate guidance for eligible members seeking enrollment assistance.
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
Customer Service Representative
Afni
01.2018 - 01.2020
- Maintained personnel records and statistical data to establish accuracy and compliance with applicable regulations.
- Managed benefits administration for company-wide staff, ensuring timely processing and accurate recordkeeping.
- Conducted routine HR audits to ensure data accuracy in personnel files, payroll records, and benefit enrollments.
- Administered employee leave requests in accordance with FMLA guidelines, maintaining compliance with regulations while providing necessary accommodations for staff members.
- Facilitated smooth onboarding processes for new hires, leading to faster integration into workplace culture.
- Coordinated employee training programs to boost skills development and improve overall performance.
- Developed and maintained up-to-date database of employee records, ensuring compliance with legal requirements.
Education
Bachelor Of Administrative Studies - Health Administration
Chattahoochee Valley Community College
Phenix City, AL08.2023
Skills
- Medical Billing & Coding (ICD-10, CPT, HCPCS)
- Claims Processing & Review
- Attention to Detail & Accuracy
- Customer Service & Communication
- HIPAA Compliance
- Microsoft Office Suite (Excel, Word,
PowerPoint, Outlook) - Epic Systems, Salesforce, and CRM software
- Data Analysis & Reporting
- Insurance Claims Resolution
Certification
- CPR & First Aid Certification
- Epic Certification
- HIPAA Compliance Training
Languages
English
Full Professional
Timeline
Medical Claims Analyst
Aspirion Health Resources
01.2020 - 08.2020
Human Resources Specialist
United States Army Reserve
12.2019 - Current
Customer Service Representative
Afni
01.2018 - 01.2020
- CPR & First Aid Certification
- Epic Certification
- HIPAA Compliance Training
Bachelor Of Administrative Studies - Health Administration
Chattahoochee Valley Community College
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