Donna K. Decker Email & Phone Number

Louisville, Kentucky, United States

Joined Business Management Systems (BMS) Department and Fortune 200 company to oversee claims functions conducted by offshore teams within multiple service areas; include health insurance claims processing, customer service call tracks, projects, and billing and enrollment. Serve in coaching role among 20 managers, team leads, SMEs, and claims adjusters.o Conduct claim adjustment analysis to reduce financial impact for health plan providers; review tickets for timely process completion. o Facilitate client executive meetings, creating and delivering detailed claims workflow presentations; contribute to increasing auto adjudication (AA) rates, mitigated interest, and state of the business recommendations to rectify issues.o Develop and maintain Business Rule Documents (BRDs), working directly with clients on comprehensive business rules.o Collaborate with quality team to meet expectations of Service Level Agreements (SLAs) and Statement of Work (SOW).KEY CONTRIBUTIONSo Revamped Call Tracker Report with added detail for claim issue resolution.o Created DENY Summary Report with comprehensive claim detail. o Developed Claims Aged Over 0 Days Report which serves as claims pending inventory tool.o Created SOPs for internal and external teams, leading to quality claims processing, reduced audits, and lower numbers in rework and penalties.

Louisville, Kentucky, United States

Joined corporate accounting team that supports 66 Goodwill stores throughout the Kentucky marketplace with increased responsibility for improving workflow procedures while processing 1000+ invoices monthly. Hired by Robert Half staffing and transitioned to permanent position with Goodwill in less than five months.o Collaborated among multi-level teams to serve retail, transportation, programs, and information technology departments.o Generated reports and conducted analysis of payments and ACH detail.o Coded invoiced items, initiating vendor communications to resolve discrepancies in orders.KEY CONTRIBUTIONSo Created SOPs for accounting department which led to consistencies and navigation of two technology systems. o Created retail desktop that houses and provides comprehensive dashboard and sorting capability.o Serve on Continuous Improvement Team to provide onsite assessment of protocols and processes.

Louisville, Kentucky, United States

Served healthcare revenue cycle management company, providing claim recovery services for hospital clients across two states and accountability for escalated high dollar accounts. Position became permanent in August 2019.o Resolved receivables and payment delinquencies for 28 hospitals involving action, appeal, and recovery methodologies; encompassed Medicare, Medicaid, Independent Practice Associations (IPAs), Management Services Organizations (MSOs), Medi-Cal, and commercial lines of business. o Navigated multiple hospital database systems to obtain medical records, EOBs, and billings and claims history.o Demonstrated in-depth understanding of The Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT), UB-04, and ICD9 / ICD10.KEY CONTRIBUTIONSo Recognized as Subject Matter Expert (SME) on reimbursement and claims resolution matters.o Selected as Superuser for contract software, PIC. Provided testing and feedback to programmer. o Edited policy and procedure documents for Collections Department manual. Trained collectors on contract interpretation, pricer tools, dispute processes, and array of processes and case complexities.

Louisville, Kentucky, United States

Advanced into analyst position where I also embraced leadership, managing and inspiring team members towards achieving our objectives while serving Special Projects Department for the third largest health insurance provider in the nation. During 13-year period, led on/offshore teams in claims processing, analytics, and project management for hospitals and medical providers across all 50 states. Received eight Quality Awards and the prestigious Humana Star Award, December 2017. KEY CONTRIBUTIONSo Trained on/offshore staff on claims processing, data capture, validation, interest and penalty calculation, and use of multiple systems. Executed leadership and development initiatives, ensured quality assurance, and drove enhanced performance and efficiency. Conducted process improvement and implementation. Recognized as SME for claims processing, project execution, and compliance within strict regulations. o Created writing and validating procedures for on/offshore validators, performing audits for feedback and improvement.o Tested new internal systems and software upgrades that included DIG Toolbar, Ppirates, and EFR.