Danielle Ross Email & Phone Number

United States

Complete Revenue Cycle Management to include all administrative and clinical A/R financial collection support. Billing, collections, appeals, reviews, and analysis reporting. To date I have collected more than 4 Million dollars in outstanding revenue.

Franklin, Tn

Assisted to bring in revenue that was more than 90 days aging. Analyzed what claims should be reviewed or written off the company books. Increased collections for EOY by 30%

Consulted in insurance billing and analysis of aged claims more than 120 days. Completed billing, follow up, appeals, and recommendations for billing write offs and advised on how to reduce these request. Collected more than 5 million in unclaimed revenue.

• Gathered Business Functional User Requirements, created Use Codes as per user requirements.• Designed and implemented EDI X12 code for the purposes of 837/835 and 276/277.• Used ICD 10 codes to complete data.• Analyzed complex data for the purposes of translating to our external customers.• Worked with various stakeholders ranging from CIO/ CTO to tax payers, Engineers, Data Specialist, and Program Managers.• Scrum Master for assigned projects.• Used VISIO and SharePoint as well as proprietary software to analyze, complete, and implement projects in both a Waterfall and Agile environment.• Provided customer support to state’s Human and Health Services regarding all facets of claim processing from point of creation to claim processing problems. • Development of standard practices such as Standard Operating Procedures (SOPs) and Action Plans. Developed training manuals for future Analyst to have the ability to complete appropriate actions for Department of Health and Human Services.• Project Manager fir telecommunications and fiber optic installation for the state of Arizona

Responsible for reconciling more than $50 Million in claims per year from Medicare, Medicaid, Private Commercial coverage, and HMO insurance payors. This process required detailed knowledge of state Medicaid processing, federal Medicare, Commercial, and HMO policy with respect to ICD-9, 10, coverage policy, adjustments, reimbursements, and denials.• Developed SOPs for 13 dialysis clinics using specific state regulations, federal policy, and corporate process.• Served as Patient Liaison for more than 178 commercial insured patients such as United HealthCare, and 300 government insured such as Medicare and Medicaid.• Worked extensively with MCOs for the purposes of processing Medicaid Reclamation claims.• Processed claims which used ICD10 knowledge, HCPCS coding, and CPT coding for the purposes of COB, 276/277, and 837/835.• Used NCPDP for the purposes for dialysis drugs and various pharmacy services patients used while on dialysis.• Extensive travel, responsible for managing and submitting all expense reports.• Ensured that all dialysis patients maintained insurance coverage and that claims were being processed working with collections, and Accounts Receivable.• Verified all requirements for processing dialysis claims were met prior to claim submittal.• Assisted in troubleshooting rejected or returned claims and claims to be processed for review.

Project Manager for ANSI X12 276/277 Project• Trained, updated, created, and translated manuals for customer service team.• Developed SOPs for department use.• Translated data from 276/277 for provider to establish patient eligibility.• Worked as BA for department with CMS to establish best practices, guidelines, expected metrics, and challenges.• Analyzed metric data in order to gather data for stakeholders.• Required research and knowledge of CMS policy, and X12 Payer Companion Guide and Eligibility Guide.• Extensive work with ANSI data sets for the 276/277 project.• Resolved escalated technical problems, customer dissatisfaction, and outages.

Liaison between Medical Review, Claims Adjusters, and Customer Service regarding Medicare Part D insurance coverage policy and regulations to provide cohesive understanding of claims processing and denial status.• Researched, analyzed, and documented federal policy for Medicare reimbursement of Part D Durable Medical Equipment (DME) for Medicare beneficiaries.• Attended meetings with various stakeholders to document important training details to be translated to CIGNA’s customer service representatives.• Trained Medicare policy manual’s that was developed by CIGNA’s Medical and Legal teams to customer service representatives.• Knowledge of processing codes, payment codes, ICD codes, denial codes, and review codes