Tracie Dooley
Melbourne
Summary
Detail-oriented and results-driven healthcare professional with experience in medical claims adjudication, insurance verification, medical billing, prior authorizations and healthcare administration. Experienced in reviewing, interpreting benefit plans and contract provisions, resolving complex claim issues and ensuring compliance with medical policies.
Overview
11
11
years of professional experience
Work History
Claims Examiner II
Health First Health Plans
03.2023 - Current
- Reviewed, adjudicated, and adjusted medical claims, ensuring compliance with contract provisions, benefit plans, and medical policies. Verified eligibility and authorization requirements, identified billing and processing trends, and resolved claim issues, ensuring accurate and timely claim adjudication. Tested Epic Systems during upgrade, validating Epic-specific functionalities to support system implementation and operational readiness. Effectively promoted from Claims Examiner I within six months of hire date.
- Evaluated claims for accuracy and compliance with policy guidelines.
- Coordinated with healthcare providers to gather necessary documentation.
- Reviewed medical records to determine claim validity and coverage.
Administrative Assistant
Atlantic Orthopaedic Group
10.2019 - 03.2023
- Verified insurance, assessed benefits eligibility, and obtained authorizations for medical services and surgical procedures to ensure timely patient care. Coordinated meetings with internal and external stakeholders while delivering high-volume customer service support, contributing to improved workflow efficiency. Scheduled surgeries during staffing vacancy, maintaining strong communication and organization for smooth scheduling processes.
- Managed patient scheduling and appointment coordination for multiple physicians.
- Handled incoming calls and responded to patient inquiries promptly and professionally.
- Assisted with medical records management and ensured accuracy of patient information.
Front Desk Receptionist
Havkin Urology
07.2016 - 10.2019
- Supported daily operations in busy healthcare practice, managing patient intake, appointment scheduling, insurance verification, and authorization processes to ensure smooth patient flow. Maintained provider schedules and prepared medical documentation for insurance approvals while collaborating with office management to coordinate surgeries, resolve billing issues, and support claims submission, enhancing operational efficiency. Delivered excellent patient service from check-in through checkout, leveraging strong organizational skills and attention to detail to improve patient satisfaction.
- Greeted patients and visitors warmly upon arrival at the healthcare facility.
- Operated a multi-line phone system to ensure calls were directed to the appropriate staff promptly.
- Arranged patient appointments and organized follow-up visits to optimize scheduling efficiency.
Medical Biller
First Choice Medical Group
07.2015 - 07.2016
- Prepared and submitted high-volume medical claims, verified accuracy of diagnoses and procedures, and educated patients on financial responsibilities to enhance patient understanding. Improved revenue through effective collections and account resolution, supporting scheduling, referrals, and daily office operations to ensure seamless office workflow. Negotiated and collected outstanding balances on delinquent accounts, generating 20% increase in revenue.
- Managed the processing of medical claims using electronic systems to ensure timely submission. using electronic billing systems efficiently.
- Conducted thorough reviews of patient records to confirm accuracy and completeness prior to submission. for accuracy and completeness before submission.
- Collaborated with healthcare providers to resolve billing inquiries and discrepancies.
CUST
- Subject 2026 Resume
- From Dooley, Tracie
- To: tntdooley@aol.com
- Date Jul 9 at 12:22 PM
- Claims Examiner II, Health First Health Plans
- March 2023-Present
- Actively participate in reviewing, adjudicating, and adjusting medical claims while ensuring compliance with contract provisions, benefit plans, and medical policies. Skilled in verifying eligibility and authorization requirements, identifying billing and processing trends, and resolving claim issues to ensure accurate and timely claim adjudication. Served as an End-User Tester during an Epic Systems upgrade, validating Epic-specific functionalities to support successful system implementation and operational readiness. Effectively promoted from Claims Examiner I within six months of hire date.
- Administrative Assistant, Atlantic Orthopaedic Group
- October 2019-March 2023
- Competent with insurance verification, benefits eligibility, and obtaining authorizations for medical services and surgical procedures. Recognized for improving workflow efficiency, coordinating meetings with internal and external stakeholders, and providing high-volume customer service support. Demonstrated adaptability by serving as Surgery Scheduler during a staffing vacancy while maintaining strong communication, organization, and attention to detail.
- Front Desk Receptionist, Havkin Urology
- July 2016-October 2019
- With experience supporting daily operations in a busy healthcare practice, managing patient intake, appointment scheduling, insurance verification, and authorization processes. Skilled in maintaining provider schedules, preparing medical documentation for insurance approvals, and collaborating with office management to coordinate surgeries, resolve billing issues, and support claims submission. Recognized for strong organizational skills, attention to detail, and delivering excellent patient service from check-in through checkout.
- Medical Biller, First Choice Medical Group
- July 2015-July 2016
- Proficient with preparing and submitting high-volume medical claims, verifying accuracy of diagnoses and procedures, and educating patients on financial responsibilities. Proven ability to improve revenue through effective collections and account resolution while supporting scheduling, referrals, and daily office operations. Generated 20% increase in revenue by negotiating and collecting outstanding balance on delinquent accounts.
- Tracie Dooley
- Claims Examiner II, Claims Administration
- Health First Health Plans
- Tracie.Dooley@hf.org
- 6450 US Highway 1
- Rockledge, FL 32955
- Hf.org
Timeline
Claims Examiner II
Health First Health Plans
03.2023 - Current
Administrative Assistant
Atlantic Orthopaedic Group
10.2019 - 03.2023
Front Desk Receptionist
Havkin Urology
07.2016 - 10.2019
Medical Biller
First Choice Medical Group
07.2015 - 07.2016