Yvette Chambers
Atlanta,GA
Summary
Seasoned Denial Management Specialist with a proven track record at Northside Hospital, adept in Revenue Cycle Management and effective appeal drafting. Demonstrates a keen ability to enhance billing and claims analysis, significantly reducing denial rates. Excels in collaborative problem-solving and comprehensive understanding of medical terminology, ensuring compliance and maximizing revenue recovery.
Overview
8
8
years of professional experience
Work History
Denial Management Specialist II
Northside Hospital
Atlanta , GA
03.2024 - Current
- Examined denied claims to identify reasons such as coding errors, missing documentation, and policy discrepancies.
- Compiled supplementary medical records and patient information for enhanced appeal preparation.
- Drafts persuasive letters to insurance companies, highlighting medical necessity for claim reconsideration.
- Engaged with insurance companies to address claim denials.
- Analyzed recurring denial patterns for billing and coding enhancements.
- Examines denial root causes to establish preventive actions.
Denial Management Specialist
Christiana Care Health System
Wilmington , DE
06.2022 - 03.2024
- Addressed and rectified payment discrepancies between patients and providers.
- Engaged in outreach efforts to recover delinquent payments.
- Ensured all accounts were accurately balanced and reconciled.
- Evaluated chart documentation to ensure accurate ICD-10 and CPT coding.
- Researched new diagnoses and procedures using various resources.
- Analyzed findings, diagnosis codes, and procedure codes provided by clinicians.
- Completed comprehensive audit reports.
- Monitored insurance benefit levels, eligibility systems, and verification procedures.
- Conducted thorough analysis of medical claims to establish compliance with required guidelines.
- Processed paper-based medical files into electronic storage systems.
- Analyzed rejection trends and developed actionable plans for denial management.
- Maintained consistent coordination with healthcare teams and insurers through written and verbal correspondence.
- Detected errors and quickly corrected refiling of disputed claims.
- Collaborated with insurance providers to rectify and resubmit disputed claims.
- Investigated coding discrepancies in CPT and ICD-9 for ensuring compliance.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Revenue Cycle/Denial Management Specialist
Thomas Eye Group
Atlanta, GA
06.2017 - 04.2022
- Resolved conflicts regarding payment issues with efficiency.
- Communicated with insurance companies to confirm policy details.
- Reviewed and assessed medical claims to ensure accuracy of documentation.
- Entered discretionary billing items to update client accounts.
- Conducted thorough examinations of inquiries and complaints to draft client appeal letters.
- Monitored and ensured accuracy in insurance coverage benefit levels.
- Transformed paper-based healthcare files into organized electronic records.
- Diagnosed issues leading to denials and formulated plans for addressing them.
- Reviewed submitted documents to ensure completeness.
- Revised and submitted claims to meet financial goals.
Education
Associates of Business Admin -
Montgomery County Community College
Blue Bell, PASkills
- Effective Appeal Drafting
- Accounts Receivable Management
- Billing and Claims Analysis
- Accounts Receivable Assessment
- Revenue Cycle Management
- ICD-10 Coding Proficiency
- Government and Commercial Claims Resolution
- Underpayment Analysis
- Medicare Compliance Knowledge
- Proficient in Insurance Benefits Analysis
- Comprehensive Understanding of Medical Terminology
- Insurance Coverage Assessment
- Understanding of DRG Systems
Timeline
Denial Management Specialist II
Northside Hospital
03.2024 - Current
Denial Management Specialist
Christiana Care Health System
06.2022 - 03.2024
Revenue Cycle/Denial Management Specialist
Thomas Eye Group
06.2017 - 04.2022
Associates of Business Admin -
Montgomery County Community College
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