Debbie Eiland Email & Phone Number

Jacksonville, Florida Area

SUMMARY OF QUALIFICATIONSHealthcare/Dental - Medical Insurance Consultant with demonstrated expertise in the clinical review of basic, major, and oral surgery procedures paid under dental, as well as oral surgery and dental trauma cases paid under medical. Performed reviews for medical necessity, possible fraud, plan provisions and state legislative guidelines. Additional experience in claims processing, training offshore (India) and local teams on clinical diagnostics and claim reviews. Private practice experience includes assisting in all phases of dentistry, financial arrangements, insurance coordination, and treatment planning.

Jacksonville, Florida Area

Reviewed dental and medical claims, appeals, trauma, and fraud cases to ensure appropriate diagnostics were performed to determine medical necessity, and that benefits were paid in accordance with plan provisions and state laws.Noted Accomplishments and Skills: Selected to work on a special project with internal fraud departments to determine if billed services were being done, billing codes were correct, and to review for duplicate submissions and payments under dental and medical. Identified savings of $60,000 to $100,000 per case on an average of 40 cases a month.Site Subject Matter Expert (SME) for oral surgery and dental/medical fraud cases. Trained all levels of staff, operations and management, local and foreign, on best practices in reviewing clinical diagnostics and claims. Assisted licensed dentists and consultants in the clinical review of dental services.

Orange Park, Fl

Assisted patients with dental procedures, examinations, cleanings, education of proper oral health techniques and insurance benefits. Created treatment plans and financial arrangements to assist patients in establishing dental priorities. Filed insurance claims and small claims cases, while maintaining accounts receivables within the office. Developed high performance standards to ensure 100% customer satisfaction.

Certificate Of Dental Assistant, Dental Radiology, And Office Management, Dental Assisting/Assistant

Completed training and certification for Dental Assistant Expanded Function Duties, Dental Radiology, and Office Management.

High School Diploma