Dawn Tutt

Strategic Healthcare Operations Professional with over 20 years of experience bridging clinical expertise and insurance administration. Seeking a remote operational role—such as Medical Claims Analyst, Intake Coordinator, or Quality Auditor—leveraging a deep understanding of medical necessity, regulatory compliance, and complex insurance workflows. Expert in the ACE platform, Availity, and Epic, with a proven track record of managing high-volume claims adjudication and medical record reviews with exceptional accuracy in independent, virtual environments.

Benefit Value Advisor (Corporate Operations) - BLUE CROSS BLUE SHIELD OF ILLINOIS - Quincy, IL

(2021-11 - 2025-09)

• Operational Excellence: Utilized the ACE system to manage complex member benefit inquiries and cost-containment strategies, ensuring 100% adherence to corporate policy guidelines.
• Claims Adjudication Support: Identified and resolved high-level billing discrepancies using ClaimsXten, reducing error rates and facilitating accurate reimbursement.
• Regulatory Compliance: Maintained strict HIPAA and internal security standards while navigating Availity and BlueApprovR to process medical necessity and prior authorization documentation.
• Data Analysis: Analyzed historical claims data and member benefits to provide strategic recommendations for cost-effective care pathways.
• Virtual Performance: Successfully managed high-volume caseloads in a fully remote environment, exceeding productivity metrics for issue resolution and member satisfaction.

Charge Nurse / Team Leader - Various Healthcare Facilities

(2008-01 - 2021-01)

• Clinical Oversight: Leveraged deep medical knowledge to lead teams and monitor clinical data for long-term care populations.
• Risk Mitigation: Conducted regular chart audits to ensure quality assurance and clinical documentation accuracy.

Medical Office Operations / LPN - SHAW CLINIC - Quincy, IL

(2004-04 - 2008-09)

• Revenue Cycle Support: Directed medical billing and ensured exact ICD-10 coding to optimize the clinic's reimbursement cycle.
• Administrative Coordination: Managed vendor relations, medical ordering, and scheduling for a high-volume medical office.
• Compliance Monitoring: Oversaw regulatory drug screening protocols and specimen processing standards.

Associates in Nursing - Nursing - John Wood Community College Quincy, IL