Danijela Pecanac
Atlanta,GA
Summary
Dynamic Billing and Credentialing Specialist with proven expertise at JF&CS in provider enrollment and claims management. Adept at enhancing revenue metrics and optimizing operations while ensuring HIPAA compliance. Recognized for resolving complex billing issues and fostering strong provider relations, demonstrating both analytical skills and a commitment to exceptional service.
Overview
29
29
years of professional experience
Work History
Billing and Credentialing Specialist
JF&CS | Clinical Services
05.2002 - Current
- Received and evaluated CAQH applications for missing and inaccurate information.
- Ensured CAQH applications meet state requirements.
- Enrolled providers Medicaid, Medicare, and private insurance plans.
- Prepared records for chart audits for Medicare and Commercial Risk Adjustment reviews.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Collected payments and applied to patient accounts.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Filed and updated patient information and medical records.
- Posted and adjusted payments from insurance companies.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Located errors and promptly refiled rejected claims.
- Identified and resolved patient billing and payment issues.
- Precisely evaluated and verified benefits and eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Printed and reviewed monthly patient aging report and solicited overdue payments.
- Improved denials, rejections and appeals
REO Research and Analysis Specialist for Oppy
Remax of Atlanta
04.2004 - 02.2012
- Provided monthly reports for forecast sales analysis.
- Assisted with initial BPO reports and provided 90-days updated BPO reports.
Rooms Control (F/D, Reservations)
Hyatt Regency
03.1997 - 05.2001
- Self-motivated, with a strong sense of personal responsibility.
- Worked flexible hours across night, weekend, and holiday shifts.
- Gained extensive knowledge in data entry, analysis and reporting.
- Worked well in a team setting, providing support and guidance.
- Completed paperwork, recognizing discrepancies, and promptly addressing for resolution.
- Resolved problems, improved operations, and provided exceptional service.
Education
InSync RCM Certification - Revenue Cycle Management
InSync RCM By Qualifacts
Florida02-2025
Medical Coding - Medical Coding
West Georgia Technical College
La Grange, GA05-2023
Associate of Science - General Studies
Georgia Sate University
Atlanta, GA05-2004
Skills
- Credentialing oversight and documentation
- Provider enrollment and Provider relations
- HIPAA and Regulatory compliance
- Credential verification
- License verifications
- Solo practitioner credentialing
- Group credentialing
- Revenue metrics analysis
- Revenue optimization
- Claims management
- Adaptable to market fluctuations
- Cost control
Accomplishments
- Achieved improved KPIs in Q1, Q2, Q3 and Q4 in FY2025
Timeline
REO Research and Analysis Specialist for Oppy
Remax of Atlanta
04.2004 - 02.2012
Billing and Credentialing Specialist
JF&CS | Clinical Services
05.2002 - Current
Rooms Control (F/D, Reservations)
Hyatt Regency
03.1997 - 05.2001
InSync RCM Certification - Revenue Cycle Management
InSync RCM By Qualifacts
Medical Coding - Medical Coding
West Georgia Technical College
Associate of Science - General Studies
Georgia Sate University