Summary
Overview
Work History
Education
Skills
Timeline
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Deanna Britain

Charleston

Summary

Experienced with managing appeals and dispute resolution processes effectively. Utilizes analytical skills to assess and resolve complex cases while ensuring compliance with regulatory standards. Track record of collaborating with teams to deliver timely and accurate outcomes, adapting to changing needs and requirements.

Overview

12
12
years of professional experience

Work History

Denials and Appeals Specialist

Conifer Health
03.2023 - Current
  • Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
  • Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
  • Consistently met or exceeded performance metrics, demonstrating a strong understanding of the claims review process and an unwavering commitment to achieving positive results for clients.
  • Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
  • Maintained high levels of accuracy in all written correspondence, ensuring clear communication with relevant stakeholders during the appeals process.
  • Expedited resolution times for appeals cases by efficiently managing workload and prioritizing urgent matters.
  • Assisted in refining company policies surrounding claims denials management by sharing insights gleaned from experiences working on various types of appeals cases.
  • Demonstrated exceptional attention to detail when evaluating medical records in order to identify discrepancies or inconsistencies that could impact an appeal''s outcome positively or negatively.
  • Reduced claim denial rates with thorough pre-appeal reviews, identifying potential issues before submission.
  • Developed strong relationships with healthcare providers, insurance companies, and regulatory agencies to facilitate successful outcomes in the appeals process.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Maintained strict confidentiality of patient information in accordance with HIPAA regulations.
  • Managed multiple priorities simultaneously while maintaining attention to detail and meeting deadlines under pressure.
  • Checked documentation for accuracy and validity on updated systems.

Billing Specialist

Patriot Med (Formerly SXR Medical)
01.2019 - 10.2022
  • Researched and resolved billing discrepancies to enable accurate billing.
  • Identified, researched, and resolved billing variances to maintain system accuracy and currency.
  • Worked with multiple departments to check proper billing information.
  • Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
  • Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
  • Maintained detailed records of each account''s payment history, providing easy access to information for audit and analysis purposes.
  • Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.

Appeals Specialist/Shift Supervisor

Community Health Systems, CHS
04.2013 - 06.2021
  • Acted as a departmental resource on appeals matters.
  • Regularly received commendations from supervisors for demonstrating exceptional commitment to customer service and dedication to client satisfaction throughout the appeals process.
  • Conducted comprehensive training sessions for new hires on proper procedures for processing claims denials and managing appeals caseloads.
  • Optimized internal communication channels between departments to ensure seamless coordination on complex appeals cases requiring input from multiple sources.
  • Played a key role in multiple successful audit reviews by maintaining meticulous records and upholding strict compliance standards in all appeal-related activities.
  • Processed and recorded new policies and claims.
  • Coordinated with contracting department to resolve payer issues.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Calculated adjustments, premiums and refunds.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
  • Trained new employees and delegated daily tasks and responsibilities.
  • Ensured smooth operations during peak hours by effectively managing resources and staff allocation.
  • Provided ongoing support to employees during challenging situations, offering guidance on problem-solving techniques for improved efficiency outcomes.
  • Continuously improved workplace processes and procedures, identifying areas for optimization and leading initiatives to implement necessary changes.

Education

Applied Science

Westark ( University of Arkansas Ft. Smith )
Fort Smith, AR

High School Diploma -

Lavaca High School
Lavaca, AR
05-1993

Skills

  • Organizational growth
  • HIPAA compliance
  • Effective communication
  • Professionalism and ethics
  • Continuous learning mindset
  • Strong analytical skills
  • Medical terminology
  • Data entry proficiency
  • Problem-solving capa
  • Critical thinking
  • Verbal and written communication
  • Team collaboration
  • Decision-making
  • Data entry
  • Task prioritization
  • Interpersonal skills
  • Analytical thinking
  • Adaptability
  • Time management abilities
  • Dispute resolution
  • Account management

Timeline

Denials and Appeals Specialist

Conifer Health
03.2023 - Current

Billing Specialist

Patriot Med (Formerly SXR Medical)
01.2019 - 10.2022

Appeals Specialist/Shift Supervisor

Community Health Systems, CHS
04.2013 - 06.2021

Applied Science

Westark ( University of Arkansas Ft. Smith )

High School Diploma -

Lavaca High School

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Deanna Britain