Candi Ward
Little Rock
Summary
Detail-oriented Medical Claims Manager with expertise in health insurance policies, coding, and compliance regulations. Efficiently reviews and analyzes claims, significantly reducing errors and streamlining processes to enhance operational efficiency.
Overview
1
1
year of post-secondary education
15
15
years of professional experience
Work History
Coordinator P2P Appeals Specialist
Corro Health
Remote Position
2022.02 - Current
- Coordinate patient scheduling and appointment management for healthcare services.
- Collaborate with multidisciplinary teams to streamline operational workflows.
- Manage documentation and data entry for patient records using electronic systems.
- Document denial reasons and tracked resolution processes effectively.
- Conduct research on policy guidelines to support claim appeals.
- Collaborated with billing departments to resolve discrepancies in claims.
Care Coordinator
IQVIA
Remote Position
2020.12 - 2022.02
- Reviewed medical claims for accuracy and compliance with policies.
- Processed claim denials and communicated resolutions to providers.
- Utilized billing software to manage claim submissions efficiently.
- Collaborated with healthcare providers to gather necessary documentation.
- Maintained up-to-date knowledge of insurance regulations and policies.
- Resolved discrepancies in claims by investigating root causes promptly.
Long Term Care Auditor
Gainwell Technologies
Remote Position
2019.08 - 2020.12
- Conducted audits to ensure compliance with regulatory standards and internal policies.
- Collaborated with teams to identify areas for process improvement and risk management.
- Prepared detailed audit reports summarizing findings and recommendations for stakeholders.
- Engaged with clients to gather information needed for thorough audit assessments.
- Analyzed data trends to support findings and inform decision-making processes at Gainwell Technologies.
- Worked closely with management to discuss external audit results and action plans.
Revenue Integrity Analyst
CARTI
Littlerock
2016.06 - 2019.09
- Generated reports on claim trends for management review and process improvement initiatives.
- Assisted in training new analysts on processes and systems used in claims management.
- Interpreted complex medical policies and procedures to determine coverage eligibility.
- Maintained current knowledge on Medicare and Medicaid guidelines as well as private insurance plans.
- Assisted in developing internal processes for efficient handling of medical claims.
- Enforced compliance with HIPAA privacy laws when dealing with sensitive information.
Access Coordinator III
UAMS Hospital
Littlerock
2014.07 - 2016.06
- Coordinated patient access and scheduling for various departments at UAMS Hospital.
- Managed incoming patient inquiries and provided accurate information promptly.
- Facilitated communication between patients and healthcare providers effectively.
- Efficiently registered patients upon arrival, ensuring accurate collection and entry of demographic and insurance information into electronic health record (EHR) systems.
- Assisted healthcare providers with medical documentation, including entering patient information into electronic health record (EHR) systems and preparing medical charts.
- Managed high volume incoming calls and inquiries from patients, families, and healthcare providers, providing information, scheduling appointments, and addressing concerns as appropriate.
OutPatient Registration Team Lead
Medical Center of South Arkansas
Eldorado
2011.06 - 2014.07
- Led team in delivering patient-centered care and ensuring compliance with healthcare standards.
- Oversaw scheduling and resource allocation to meet departmental needs effectively.
- Coordinated daily operations to enhance workflow efficiency and staff collaboration.
- Developed strategies to increase team productivity and improve customer service levels.
- Trained new staff on protocols, procedures, and best practices in patient care.
- Assessed team performance regularly to identify training needs and improve skills.
Education
Bachelor of Science - Health Services Administration Management
American InterContinental University
Schaumburg, IL 2021.05 - 2022.08
Skills
- Claims management
- Insurance verification
- Medical billing
- Patient registration
- Patient scheduling
- Compliance reporting
- Healthcare regulations
- Documentation management
- Policy implementation
- Process improvement
- Cross-functional coordination
- Operational oversight
- Project timelines
- Data entry
- Risk management
- Schedule coordination
Timeline
Coordinator P2P Appeals Specialist
Corro Health
2022.02 - Current
Bachelor of Science - Health Services Administration Management
American InterContinental University
2021.05 - 2022.08
Care Coordinator
IQVIA
2020.12 - 2022.02
Long Term Care Auditor
Gainwell Technologies
2019.08 - 2020.12
Revenue Integrity Analyst
CARTI
2016.06 - 2019.09
Access Coordinator III
UAMS Hospital
2014.07 - 2016.06
OutPatient Registration Team Lead
Medical Center of South Arkansas
2011.06 - 2014.07