Dawn Fairclough
@dawnfairclough1
Dedicated payment resolution specialist with extensive healthcare experience.
United StatesWhat I'm looking for
I am a seasoned Payment Resolution Specialist with over 20 years of experience in patient financial services, primarily within Trinity Health System. My career has been dedicated to resolving denial issues and ensuring accurate billing processes for both government and non-government payors. I excel in researching payor policies, verifying insurance coverage, and preparing appeals with supporting medical documentation.
Throughout my tenure, I have honed my skills in monitoring facility claims, identifying coding errors, and collaborating with various departments to ensure timely resolutions. My commitment to excellence is reflected in my ability to train new staff, create comprehensive training manuals, and maintain strict confidentiality while managing sensitive patient information. I am passionate about improving processes and reducing departmental costs through effective problem-solving and decision-making.
Experience
Work history, roles, and key accomplishments
Payment Resolution Specialist
Trinity Health System
Jan 2022 - Dec 2025 (3 years 11 months)
Identified, followed up, and resolved denial issues and claim status for Government and Non-Government payors utilizing EOBs and payor portals. Researched payor policies to identify reasons for denial issues and verified insurance coverage.
Billing and Follow Up
Trinity Health System
Jan 2019 - Dec 2022 (3 years 11 months)
Monitored facility claims submitted to government collectors (Medicaid and Medicare) for payment. Reviewed denied claims, researched, and submitted corrected claims, identifying coding or submission errors.
Release of Information
Trinity Health System
Jan 2000 - Dec 2019 (19 years 11 months)
Investigated and responded to patient/family complaints, ensuring validity of personal, professional, insurance, and attorney requests. Coordinated the submission of records for audits, denials, and subpoenas, acting as court liaison when records were subpoenaed.
Education
Degrees, certifications, and relevant coursework
Eastern Gateway Community College
Associate of Applied Business, Business Management
Completed an Associate of Applied Business degree focusing on business management principles and practices. Gained foundational knowledge in various aspects of business operations.
AHIMA online
Certificate, Coding and Billing
Obtained a Coding and Billing Certificate through AHIMA online. Developed expertise in medical coding and billing procedures, preparing for roles in healthcare financial services.
Eastern Gateway Community College
Certificate, Accounting
Studied accounting principles and practices at Eastern Gateway Community College. Acquired knowledge in financial record-keeping, analysis, and reporting.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
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