Summary
Overview
Work History
Education
Skills
Timeline
Generic

Amanda Duncan

Casa Grande

Summary

Results-driven professional with a strong focus on financial documentation and management. Demonstrated expertise in accurate billing, data entry, and account reconciliation, leading to enhanced productivity and client satisfaction. Known for exceptional multitasking skills and effective time management, consistently surpassing performance goals while contributing to team success. Aiming to leverage problem-solving abilities and communication skills for continued career growth in a dynamic environment.

Overview

14
14
years of professional experience

Work History

Reimbursement Specialist

Novartis Pharmaceuticals
Tempe
10.2023 - 11.2024
  • Analyzed and approved reimbursement claims following company guidelines.
  • Verified the precision of reimbursement details through thorough analysis of patient data.
  • Trained new staff on accurate submission processes for reimbursement requests.
  • Performed in-depth analysis of billing procedures to pinpoint potential savings.
  • Reviewed and verified necessary paperwork prior to finalizing requests.
  • Cultivated strategic alliances with insurance companies to ensure timely reimbursements.
  • Resolved challenges related to reimbursement hurdles.
  • Evaluated coverage criteria according to specific insurer policies.
  • Strictly adhered to compliance requirements for reimbursements.
  • Evaluated existing systems used for tracking reimbursements and proposed improvements as needed.
  • Gathered information to produce accounts payable reports for review.
  • Advised supervisors and clinicians of billing deficiencies to support charge capture.

Medical Accounts Receivable

Integra Connect (GMR/AMR)
06.2021 - 06.2023
  • Oversaw entire follow-up process for various insurance claims.
  • Executed timely resolution of outstanding accounts in multiple areas.
  • Updated appropriate modifiers and resolved payment issues with carriers.
  • Utilized advanced technical skills and expertise to troubleshoot complex problems and implement solutions.
  • Collaborated closely with team members to achieve project objectives and meet deadlines.
  • Worked with cross-functional teams to achieve goals.
  • Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
  • Contributed innovative ideas and solutions to enhance team performance and outcomes.

Claims and Appeals Specialist

Triwest
Phoenix
10.2019 - 06.2021
  • Reviewed inpatient and outpatient service claims for accuracy and compliance.
  • Conducted reviews using clinical, coding, and processing knowledge.
  • Collected essential information to support payment case preparation.
  • Maintain compliance with program benefits as authorized.
  • Delivered essential clinical and coding-related details for quality management and program integrity purposes.
  • Guided clinical and non-clinical teams on claims issues.
  • Identified trends in the types of appeals received, and reported those findings to management.
  • Analyzed medical records to determine if further information was needed in order to process appeals.
  • Demonstrated ability to work independently as well as collaboratively within a team environment.

Reimbursement Specialist Appeals

Guardant Health
The Woodlands
09.2018 - 10.2019
  • Tracked, reported, and resolved complex outstanding claims.
  • Resolved EOB discrepancies while managing claim appeals and payment adjustments.
  • Oversee documentation for payer communication.
  • Handled inbound billing and payment calls.
  • Processed patient payments into corresponding accounts.
  • Worked with A/R staff to identify and resolve missing payments.
  • Researched rejections, investigating problems to appeal claims.
  • Determined medical necessity, using individual insurance carrier regulations.
  • Performed insurance verification, pre-certification and pre-authorization.
  • Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
  • Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.

Appeals Team Lead

Meddata
The Woodlands
06.2018 - 09.2018
  • Managed multiple projects within the Appeals and Denial revenue cycle.
  • Ensured compliance with HIPAA regulations.
  • Developed expertise in processing commercial insurance, Medicare, and Medicaid billing claims.
  • Processed intricate appeal cases involving various denials efficiently.
  • Managed accounts receivable for numerous clients.
  • Conducted employee audits, including victims' cases.
  • Proficient in reading and recognizing UB04 and HCFA forms.

Installed Sales Coordinator

Lowe's
Tomball
06.2018 - 09.2018
  • Responsible for coordinating and scheduling installations by reviewing and managing Installed Sales paperwork and contacting installers and customers throughout the process
  • Ensuring merchandise is ready for installer pickup or delivery by pulling and staging items beforehand, and confirming customer satisfaction
  • Also responsible for communicating and building relationships with installers, customers, and vendors and for assisting with the training and coaching of employees on the Installed Sales program and order management system

Claims Examiner

Blue Cross Blue Shield of AZ
Phoenix
07.2017 - 12.2017
  • Managed full range of company insurance products with timely and precise claim adjudication.
  • Managed claim adjustments and fund recovery on a daily basis.
  • Conducted secondary evaluations of original investigations documentation and reports to facilitate smooth resolutions.
  • Entered claim transactions, payments, reserves and other documentation.
  • Utilized claims processing software to manage and track claim progress.
  • Managed workloads efficiently by prioritizing tasks based on urgency or importance.

Claims Analyst, Processor 1

CVS CAREMARK
Phoenix
01.2015 - 06.2017
  • Addressed member claims submissions promptly and accurately.
  • Identified opportunities for improving existing quality assurance standards.
  • Elevated employee skills through updated procedural guidelines.
  • Oversaw the lifecycle of ad-hoc projects with existing tools, coordinating inter-team collaboration for successful budgetary compliance.
  • Collaborated with cross-functional teams, coordinated team meetings, and oversaw agendas and action items.
  • Perform precise daily adjudication of electronically imaged claims in a fast-paced setting.
  • Assess authenticity of paper claims following client guidelines.
  • Identify paper claims' processing requirements.
  • Handled appeals and grievances related to paper claim problems.
  • Documented all claims activities clearly and concisely in the claims management system.

Pharmacy Claims Research & Correspondence Specialist (Claims Processor)

COGNIZANT / ESI
Phoenix
03.2013 - 01.2015
  • Verify eligibility of members for claims reimbursement
  • Conducted quality control while maintaining production goals
  • Work with dual monitors, multiple systems, tracking and records each document
  • Train new associates on how to be detail oriented and thoroughly research the claims to produce a high quality score and get claims paid, or, communicate with members
  • Manage and process medical claims
  • Research and correspondence on improperly filled medical claims
  • Send correct correspondence letters to members on requested information necessary to complete and pay the claim
  • Data capture information into electronic programs from Medco and ESI (Express Scripts Inc)

BPO Admin/Data Entry

COGNIZANT
Des Moines
02.2011 - 03.2013
  • Same job duties as above for ING but performed as Cognizant employee, also training with the tax
  • Mail room clerk ING position - Identified documents by company and policy number to be entered into the workflow systems
  • Prepared documents for scanning
  • This may include, but is not limited to opening mail, sorting, prepping and indexing
  • Researched documents improperly numbered
  • Supported indexing of faxed documents
  • Processing, rescan and box pull requests
  • Mail sort and route documents to respective work groups
  • Other duties as assigned
  • Responsible for incoming and outgoing mail for both internal and external business
  • This includes receiving, sorting, delivering and sending of mail

Education

High School Equivalency -

DMACC
Des Moines, IA
06.2005

Skills

  • Customer Service
  • Denial management
  • Medical billing
  • Appeals handling
  • Medicaid / Medicare
  • Commercial insurance
  • Self motivation
  • Billing reconciliation
  • Document Preparation Skills
  • Production and quality
  • Adjudication of claims
  • SME
  • Excellent computer skills, including 10-key
  • Microsoft 365, Word, Office, Excel
  • Issue resolution
  • Employee training
  • Policy interpretation
  • Medical terminology
  • Billing documentation
  • CPT, HCPCS, ICD-10
  • Reimbursement analysis
  • Claims processing
  • Claims resolution
  • Insurance verification
  • Analytical skills
  • Work Planning and Prioritization

Timeline

Reimbursement Specialist

Novartis Pharmaceuticals
10.2023 - 11.2024

Medical Accounts Receivable

Integra Connect (GMR/AMR)
06.2021 - 06.2023

Claims and Appeals Specialist

Triwest
10.2019 - 06.2021

Reimbursement Specialist Appeals

Guardant Health
09.2018 - 10.2019

Appeals Team Lead

Meddata
06.2018 - 09.2018

Installed Sales Coordinator

Lowe's
06.2018 - 09.2018

Claims Examiner

Blue Cross Blue Shield of AZ
07.2017 - 12.2017

Claims Analyst, Processor 1

CVS CAREMARK
01.2015 - 06.2017

Pharmacy Claims Research & Correspondence Specialist (Claims Processor)

COGNIZANT / ESI
03.2013 - 01.2015

BPO Admin/Data Entry

COGNIZANT
02.2011 - 03.2013

High School Equivalency -

DMACC

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Amanda Duncan