Derrick Strover Duncan
Minneapolis
Summary
Detail-oriented and highly skilled Revenue Cycle Specialist with expertise in Workers’ Compensation claims processing. Adept at identifying and correcting claim errors, ensuring compliance with departmental production standards, and effectively utilizing third-party resources to reconcile accounts. Proficient in processing third-party rejections, following up on open accounts receivable, and re-filing claims using advanced knowledge of payor and billing systems.
Experienced in leveraging Excellian and other relevant systems for claims processing, registration, and verification, ensuring accurate data management. Skilled in trend analysis, appeals, and resolution of low-payment or underpaid accounts, as well as handling complex denials related to coding, medical necessity, and RAC technical issues. Capable of resolving challenging revenue cycle situations, ensuring timely reimbursement from third-party payers.
Strong collaborator with a keen ability to identify workflow inefficiencies and contribute to the development of policies, procedures, and training materials. Provides guidance and job shadowing to team members, fostering an environment of continuous learning and process improvement.
Overview
3
3
years of professional experience
Work History
Senior Insurance Specialist
Allina Health
09.2022 - Current
- Understand edits and appropriate department procedures to effectively submit and/or correct errors on claims to the production standards of the department
- Utilize various resources such as third-party publications, procedure manuals and participating contractual agreements, etc
- To reconcile accounts
- Advanced knowledge and understanding to process third party rejections using the Payor system and the billing system
- Follow-up on open accounts receivable, re-filing and department status procedures
- Utilize Excellian and various systems and demonstrate understanding of procedures for registration/verification modules, Claims Processing system, Web based provider systems, etc, if applicable to position
- Trend analysis, Appeals and Resolves of low payment or underpaid accounts
- Reports to lead and or supervisor observations of WQ's and workflow processes that may need further review and or development
- Process and resolve complex denials related to coding and site operations (i.e.: CPT related, medical necessity, RAC technical denials etc)
- Ability to deal with difficult revenue cycle situations and resolve issues delaying/preventing payments from 3rd party payers
- May be asked to provide job shadowing/basic training to other team members on the specific nuances of various job functions
- May assist in the design and development of department policies, procedures and tip sheets
- Attend and participate in biweekly staff meetings and any other meetings andor training sessions as indicated
- Extreme ability to organize and track large amounts of data
- Verification Benchmarks are met on a time frame as established by Management
- Ability to work in multiple software programs
CW Optum Insurance Representative Senior
Optum
05.2024 - 03.2025
- Handled correspondence, scheduling and contracts for appearances.
- Generated and proofread professional business correspondence, financial reports, and tracking spreadsheets.
- Completed reports, charting, scheduling, and daily correspondence.
- Handled incoming calls and correspondence and responded as directed.
- Typed up professional business correspondence, reports, and other documents.
- Responded to correspondence from insurance companies.
- Handled incoming calls and correspondence to respond to questions and inquiries.
- Supported office manager with proactive correspondence management, document coordination, and customer relations.
- Understand edits and appropriate department procedures to effectively submit and/or correct errors on claims to the production standards of the department.
- Advanced knowledge and understanding to process third party rejections using the Payor system and the billing system. Follow-up on open accounts receivable, re-filing and department status procedures.
- Utilize Epic and various systems and demonstrate understanding of procedures for registration/verification modules, Claims Processing system, Web based provider systems, etc, if applicable to position • Trend analysis, Appeals and Resolves of low payment or underpaid accounts Reports to lead and or supervisor observations of WQ’s and workflow processes that may need further review and or development • Process and resolve complex denials related to coding and site operations (i.e.: CPT related, medical necessity, RAC technical denials etc).
- Ability to deal with difficult revenue cycle situations and resolve issues delaying/preventing payments from 3rd party payers.
- Provide job shadowing/basic training to other team members on the specific nuances of various job functions.
- Assists in the design and development of department policies, procedures and tip sheets.
Education
Bachelor of Science - Software Engineering
St. Cloud State University
05-2025
Associate of Science - Engineering
Anoka Ramsey Community College
08-2023
Skills
- Claims Processing & Error Correction
- Third-party Payor Systems
- Billing & Reimbursement
- Correspondence
- Revenue Cycle Management
- Denial Management & Appeals
- Trend Analysis & Process Improvement
- System Proficiency
- Training & Development
- Policy & Procedure Development
Timeline
CW Optum Insurance Representative Senior
Optum
05.2024 - 03.2025
Senior Insurance Specialist
Allina Health
09.2022 - Current
Associate of Science - Engineering
Anoka Ramsey Community College
Bachelor of Science - Software Engineering
St. Cloud State University
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