Zoe Nielsen
Valdosta
Summary
Healthcare professional with a focus on improving operational efficiency and service delivery. Expertise in data entry, file management, and office administration enhances productivity. Strong organizational skills and multitasking abilities drive effective problem-solving and support team goals.
Overview
8
8
years of professional experience
Work History
Dispute Resolution Analyst
TMF Health Quality Institute
Remote
06.2025 - 09.2025
- Manage the delivery of re-determination files, dispute resolution documents, and reconsideration decisions for medical claims.
- Create and analyze reconsideration case files using submitted evidence to ensure they meet specific customer entity criteria.
- Evaluate cases based on type (medical/non-medical), appeal category, request validity, and dispute resolution documentation.
- Enter relevant data for reconsideration and dispute resolution cases into required systems.
- Address reconsideration and dispute review requests from health care plans, patients, and providers.
Patient enrollment / POD Leader
SalesMD
Remote
09.2024 - 09.2025
- Respond to leads, enquiries, and answer incoming telephone calls, SMS messages, and emails, as well as completed lead forms received by the booking contact center.
- Collect and accurately enter information into customer electronic systems.
- Understand and effectively use booking center training materials; adhere to policies and procedures.
- Call and scheduling volume of 35 or more daily.
- Managed customer accounts to ensure timely collection of outstanding payments.
Medical Clerk
Tristate Spine Sport and Surgery
Remote
01.2022 - 08.2024
- Manage patient records, ensuring accurate insurance claims and authorizations for pain management and ambulatory center.
- Managed patient scheduling and appointment coordination for efficient clinic operations.
- Communicated with insurance companies to verify patient coverage and benefits.
- Reviewed and processed prior authorization requests for medical services.
Assistant Office Manager
Stones Heating and Air
Adel
03.2020 - 04.2024
- Coordinated office and field teams to enhance project efficiency and client satisfaction.
- Implemented scheduling software, minimizing appointment conflicts and optimizing resource allocation.
- Managed financial and customer accounts to ensure timely payments and maintain vendor relations.
- Assisted management with complex scheduling, dispatching, and confidential tasks.
- Handled over 60 incoming and outgoing calls daily, focusing on customer relationship management.
Healthcare Clerk
Integrated Healthcare Services
Newburgh
11.2017 - 03.2020
- Managed appointment schedules, enhancing patient flow, and reducing wait times.
- Resolved insurance discrepancies and patient collections, ensuring high billing accuracy, and improved financial outcomes.
- Maintained medical records with HIPAA compliance, conducting audits for data integrity.
- Requested and maintained authorizations, supporting necessary medical needs efficiently.
- Processed patient information using electronic health record systems.
Education
High School Diploma -
The American Academy
Salt Lake City, UT, Online03.2023
Some College (No Degree) - Business Administration Tech
Northeastern Oklahoma A&M College
Miami, OK, OnlineSkills
- Analytical thinking
- Adaptability
- Medical Case Management
- Negotiation
- Claim Analysis
- HIPAA and HITECH
- CMS
- QuickBooks Pro
- Aetna Health
- NextGen
- Availity
- SharePoint
- Microsoft 365
- Salesforce
- Medallion
- NetSuite
- AdvancedMD
- CAQH
Timeline
Dispute Resolution Analyst
TMF Health Quality Institute
06.2025 - 09.2025
Patient enrollment / POD Leader
SalesMD
09.2024 - 09.2025
Medical Clerk
Tristate Spine Sport and Surgery
01.2022 - 08.2024
Assistant Office Manager
Stones Heating and Air
03.2020 - 04.2024
Healthcare Clerk
Integrated Healthcare Services
11.2017 - 03.2020
High School Diploma -
The American Academy
Some College (No Degree) - Business Administration Tech
Northeastern Oklahoma A&M College
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