KAYCEE PRESNALL
CHARLOTTE
Summary
Detail-oriented and experienced Claims Specialist with a strong background in health insurance processing, claims adjudication, and compliance. Proficient in ICD-10, CPT coding, claims investigation, and data analysis. Skilled in improving claims workflows and resolving discrepancies with 98% to 99% accuracy. Known for excellent customer service and the ability to enhance operational efficiency in fast-paced environments.
Overview
6
6
years of professional experience
Work History
Dispute Resolution Specialist
Claritev
07.2025 - Current
- Collaborated with cross-functional teams to streamline dispute resolution procedures.
- Documented case details accurately in the dispute management system for tracking.
- Maintain departmental productivity, quality standards, and compliance with HIPAA privacy regulations.
- Review clinical and supporting documents from providers to build accurate, compliant submissions.
- Conduct due diligence through the portal, application, and online research to support case preparation.
CLAIMS RESOLUTION SPECIALIST(CONTRACT)
WPS Health Solutions
01.2024 - 01.2025
- Resolved discrepancies in submitted claims documentation, identifying and correcting errors.
- Entered claim data into internal systems with 99% accuracy.
- Achieved a 15% reduction in processing time by streamlining workflows.
- Maintained detailed communication records for claims transparency.
TRANSACTION PROCESSOR( CONTRACT)
HealthEquity
12.2022 - 01.2024
- Processed over 1,000 medical claims monthly while ensuring regulatory compliance.
- Analyzed claims and supporting documentation to validate accuracy.
- Improved claim accuracy to 98% by refining internal review procedures.
- Adhered to HIPAA and organizational standards consistently.
SCHEDULING COORDINATOR
Redfin
07.2019 - 11.2022
- Scheduled and coordinated 200+ monthly settlement appointments.
- Managed calendars for multiple teams and resolved scheduling conflicts.
- Delivered high-quality client service during the real estate closing process.
- Collaborated with internal teams to optimize resource allocation.
Skills
- Claims processing and adjudication
- ICD-10 and CPT coding
- HIPAA compliance
- Medical billing
- Claims investigation
- Workflow optimization
- Customer service
- Microsoft Office proficiency
- Google Suite proficiency
- Data entry and analysis
Accomplishments
- Reduced claim processing errors by 15% through meticulous validation.
- Led workflow improvements that boosted processing speed by 20%.
- Recognized for exceptional customer service with a 98% satisfaction rate.
Timeline
Dispute Resolution Specialist
Claritev
07.2025 - Current
CLAIMS RESOLUTION SPECIALIST(CONTRACT)
WPS Health Solutions
01.2024 - 01.2025
TRANSACTION PROCESSOR( CONTRACT)
HealthEquity
12.2022 - 01.2024
SCHEDULING COORDINATOR
Redfin
07.2019 - 11.2022