Deborah Knight Clark

Researches and processes provider/member appeals and grievances related to NIOSH complaints submitted to the World Trade Center Health Program (WTCHP). Resolves issues involving access to care, claim underpayments/denials, participation, membership/eligibility, claims errors, and prior authorization/medical review denials.

Researches and processes regulatory member complaints submitted to DOI, BBB, and via congressional/ERU channels, and resolves related issues. Performs root-cause analysis across billing/claims, contracting, eligibility, coding, configuration errors, and supports written resolutions and call-review coaching.

Researches and resolves regulatory member complaints filed with DOI, BBB, and congressional/ERU channels. Utilizes payer/member/provider portals and conducts root-cause analysis for issues such as billing, claims, contracting, membership/eligibility, access to care, and coding.

Ensures compliance with grievance and appeals processes and regulatory guidelines (CMS, DHCS, DMHC) by coordinating, documenting, and tracking cases. Prepares written correspondence to providers, members, and regulatory entities and supports assignment and investigation workflows within regulatory timelines.

Audits inpatient and outpatient hospital claims for underpayments based on legal contracts. Verifies underpayments with insurance companies, submits appeals/disputes via portals or paper, and helps resolve contract issues with provider and payor stakeholders.

Bills home healthcare claims using 837 forms for commercial, Medicaid, and Medicare, and supports self-pay client inquiries. Researches work calendars for corrected claim submissions and contacts insurance carriers to assist with root-cause analysis for denials.

Bills and collects medical claims using NextGen software, including Medicaid and commercial insurance claims. Performs account research and reconciliations, posts payments, and supports collections calls while analyzing denial reasons and payment trends.

Gathers member and provider information to submit payment appeals and ensures provider data is current and complete for claims processing. Performs audits, follows up on missing documentation, conducts root-cause analysis, and manages appeals end-to-end including medical record pull and decision letter preparation.

Reviews denied claims to determine denial reasons and submits appeals for payment. Processes UB-04/1500/1504 claims, performs coding validation (ICD-10/CPT), and executes root-cause analysis including provider credentialing inconsistencies.

Manages billing and collections for optometric and ophthalmology claims, including correcting and resubmitting claims via paper and electronically. Tracks A/R reports for multiple offices, posts payments, handles appeals, and performs patient balance collections.

Works on claim appeals and reimbursement by collecting from commercial carriers, Medicare, and Medicaid. Corrects and resubmits prescription/IV medication claims, corrects coding with HCPCS codes, and supports patient balance collections and downstream claim follow-ups.

Corrects and resubmits inpatient and outpatient hospital claims and performs accounts receivable and appeals work. Supports insurance verifications, Medicare secondary coordination, and processes EOBs and COBs while handling MU/PIP denials and submitting claims across multiple payers.

Performs medical billing and collections using ADS Medics Elite and Docs Assistant for electronic document management. Handles claim submission (electronic and paper), payments, AR/AP, insurance verification, referrals, and provides SME support for new employees.

Handles medical billing and collections with a focus on Medicare payment processing, recurring accounts, and Medicare secondary payer. Corrects and submits claims electronically and supports accounts receivable reporting and appeals processing using multiple billing systems.

Enters and processes charges, performs insurance verification, and submits claims electronically and via paper. Coordinates outpatient treatment report authorizations and bills/collects for legal cases, PIP, work-related compensation, and government/self-pay categories.

Bachelor’s in Business Administration/Healthcare at Strayer University starting in 2019 and currently in progress.

Completed some college coursework in Health Administration at the University of Phoenix in Miami, FL.

Completed high school or equivalent education at Lindsey Hopkins Technical Education Center in Miami, FL.