Daphne Spivey
Senior Claims Analyst @CareCloud
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WORK HISTORY
Senior Claims Analyst @CareCloud
Miami, FL, US
Analyze data in various ways to identify trends to create CIQ Edits and or Directives.Oversees 35 plus accounts that are being worked by offshore team.Create spreadsheets and pivot tables of outstanding claims to send to offshore team.Analysis of internal data to assess and analyze performance. Assist Client Manager in finding and fixing issues with clients account. Suggest and helpimplement ways to increase the clients NPS scores, KPI\'s and Metrics.Assist in the follow up of all Workman\'s Comp, and PIP Claims as well as review Provider Appeals,Write offs and Adjustments created by offshore team.Reviewing Contracts to make sure claims are being reimbursed at the negotiated contract rate.Stay current with Coding changes that directly impact the physician practices.Make sure that we stay compliant with all federal programs and that we do not breach our contracts with insurance companiesImplemented a successful system for intensive and comprehensive follow-up for all non-responsiveinsurance companies approaching the 45-day limit for payment.Skillfully developed departmental goals, objectives, standards of performance, policies andprocedures.
EDUCATION
NCCT
Insurance and Coding Specialist, Coding
National healthcare Association
Certified Billing and Coding Specialist
Miami Dade College
Medical Insurance Coding Specialist/Coder
SKILLS
ABOUT DAPHNE SPIVEY
LinkedIn Profile Summary:With over 15 years of experience in the Medical Field, I have dedicated the last decade to specializing in Accounts Receivable, Denials Management, and Appeals. My passion lies in conducting thorough research to ensure the effectiveness of my appeals, resulting in successful denials overturn.My motto is simple:\"The payers have people working hard on their side, and so should you.\" This belief has driven me to excel in my role as an AR Analyst, with a strong focus on Key Performance Indicators (KPIs) and an impressive 95% Appeal Success Rate. I take pride in my ability to facilitate Payer Recoupment Recovery and maintain AR levels above +90, with less than 10% of total AR outstanding.As a professional, I possess excellent oral and written communication skills, and I am well-versed in HIPAA regulations. Being a team player, I thrive in collaborative environments and am proficient in various healthcare systems, including Athena, Soarian Financial and Power Chart. My proficiency extends to all Microsoft applications, including the use of Pivot Tables for insightful data analysis. Moreover, I have a proven track record in conflict resolution and the ability to identify trends, particularly related to ICD-10, Medicare, and Medicaid regulations.Beyond my technical expertise, I pride myself on being a people person, fostering positive working relationships with colleagues and stakeholders alike. My wealth of experience has equipped me to bring a substantial amount of knowledge and expertise to your organization, making me a valuable addition to any team.Let\'s connect and explore potential opportunities to collaborate for mutual success.
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