Open to opportunities

Dria fenty

@driafenty

Message

Detail-oriented healthcare professional with expertise in medical records management.

United States

Message

What I'm looking for

I am looking for a role that allows me to leverage my healthcare experience while contributing to compliance and operational efficiency in a collaborative environment.

I am a detail-oriented and highly organized healthcare professional with over 8 years of experience in medical records, insurance verification, payment posting, and claims follow-up. My expertise lies in ICD-10-CM/CPT coding application, billing support, and insurance reconciliation. I am adept at analyzing clinical documentation, ensuring HIPAA compliance, and collaborating across departments to resolve denials and maintain data accuracy.

Currently, I am pursuing a degree in Public Health to further strengthen my compliance and analytical expertise. In my role as a Healthcare Operations Specialist at Humana, I have successfully transitioned through various responsibilities, including eligibility verification, authorizations, and claims management. My commitment to process improvements and cross-department training has significantly enhanced compliance and operational efficiency.

Experience

Work history, roles, and key accomplishments

Current

Healthcare Operations Specialist

Current

Humana

Apr 2022 - Present (3 years 3 months)

Verified coverage details across commercial and government health plans, confirming member benefits and network participation. Reviewed clinical documentation for medical necessity, ensuring procedures met policy criteria for approval and communicating with providers to resolve incomplete requests. Focused on denial code interpretation, researching root causes of rejections, and taking corrective

Authorization Claims Management HIPAA Microsoft Excel Process Improvement

Medical Records Specialist

Ciox Health

Dec 2021 - Apr 2022 (4 months)

Reviewed clinical records for compliance with release policies and HIPAA regulations, processing patient, legal, and provider requests with high attention to accuracy. Ensured only specific requested records were released, adhering strictly to HIPAA guidelines and verifying valid authorization forms. Operated within multiple EHR systems including Allscripts, Epic, and Centene, adapting quickly to

HIPAA Allscripts Epic Centene)Confidentiality Documentation

Verification Specialist

Northwell Health

Jan 2017 - Dec 2021 (4 years 11 months)

Scheduled outpatient appointments and verified insurance coverage for multi-specialty services, obtaining referrals and prior authorizations for various procedures. Explained patient responsibilities and insurance coverage clearly to improve understanding and reduce confusion. Managed office operations in the supervisor's absence, provided on-the-job training, and identified process gaps to enhanc

Scheduling Customer Service Office Management Staff Training Process Improvement

Education

Degrees, certifications, and relevant coursework

Empire State University

Bachelor's in Public Health, Public Health

Currently pursuing a Bachelor's degree in Public Health to further strengthen compliance and analytical expertise. This program focuses on public health principles and practices.