Alice Davis
Dallas,TX
Summary
Seeking a highly collaborative role working with all departments to incorporate a high-level client vision. To exceed the expectations of my employer consistently and diligently, plan, design, and implement new interactive ways to increase the company's revenue. Manage and provide high-level strategic guidance as well as day-to-day mentorship for the team members. To offer individuality and to develop a working relationship with senior management regarding projects.
Experienced leader with strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for collaborative approach and commitment to excellence.
Overview
18
18
years of professional experience
Work History
Claims Analyst
UnitedHealthcare
01.2022 - Current
- Evaluate and negotiate rates between Kaiser Permanente and various medical groups and providers
- Research, investigate, and review the provider's area Medicare and commercial rates before starting the negotiation process, and issuing a Letter of Agreement to the provider or facility
- Provide information to the provider regarding Kaiser rates and guidelines
- Contact Kaiser medical staff to go over each patient's clinicals to ensure the best rates are negotiated
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
Senior Medical Billing Manager
Plutus Medical Billing and Collections
01.2021 - 01.2022
- Set up necessary steps for onboarding providers which may include but not limited to credentialing, setting up electronic vendors, assist with fee schedules and SOP's if needed
- Provide weekly KPI reports to each provider to surpass monthly goals
- Increased patient satisfaction by addressing billing inquiries promptly and professionally.
- Reduced denied claims through diligent review, correction, and resubmission of errors.
- Developed strong relationships with insurance companies through effective communication and negotiation skills, enhancing payment turnaround times.
- Managed a team of dedicated medical billers, focusing on professional development opportunities and maintaining a positive work environment conducive to high levels of productivity.
- Enhanced revenue cycle management by overseeing timely and accurate claims submission.
- Trained team members on best practices in medical billing, ensuring consistent high-quality work across the department.
- Developed policies and procedures for the medical billing department, establishing a strong foundation that supported growth and operational success within the organization.
- Optimized cash flow by regularly reviewing aging account balances and implementing tactics for timely collections from patients or insurers.
- Analyzed reports to identify areas for improvement in the overall billing process, leading to increased revenue collection rates.
- Served as an expert resource on complex patient account issues or high-dollar claims requiring specialized handling, ultimately resolving outstanding balances in an efficient manner.
- Managed monthly billing process to complete billings and returns to meet company revenue recognition policies.
Senior Medical Biller
DIGESTIVE HEALTH ASSOCIATE BILLING GROUP
01.2018 - 01.2021
- Perform full cycle medical insurance collections for multi-physician and hospital services
- Follow up, correct, appeal and or re-submit corrected claims to payer
- Keying and Re-keying medical charges
- Making all negotiated adjustments
- Verifying payable diagnosis with Code-link and McKesson
- Delivered timely and accurate charge submissions.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Adhered to established standards to safeguard patients' health information.
- Responded to customer concerns and questions on daily basis.
- Used data entry skills to accurately document and input statements.
- Handled account payments and provided information regarding outstanding balances.
- Audited and corrected billing and posting documents for accuracy.
- Collaborated with customers to resolve disputes.
- Utilized various software programs to process customer payments.
- Reduced claim denials by diligently reviewing patient information and verifying insurance coverage.
- Enhanced revenue by efficiently processing medical billing claims and ensuring accuracy.
Billing/ Practice Manager
CLAIMCARE MEDICAL BILLING GROUP
01.2013 - 01.2018
- Supervision of patient scheduling, registration, financial counseling, medical records, billing and collection, data entry and processing and cash posting
- Develop, implement, and maintain office policies and procedures
- Interview, hire and train a productive medical office team and conduct performance reviews
- Communication with patients regarding their accounts and processing of appeals and correspondence
- Experience with Medicare/Commercial Insurance and related billing functions
- Addressed patient concerns promptly and professionally, demonstrating empathy and excellent problem-solving skills.
- Managed daily practice operations to optimize appointment scheduling, patient records management and billing functions.
- Ordered all office supplies and kept check on inventory levels.
- Facilitated communication between staff members, fostering a collaborative work environment that improved overall team performance.
- Managed all aspects of billing and coding, reducing errors and improving reimbursement rates.
- Conducted thorough market analysis to identify trends and opportunities for practice growth.
- Improved patient flow through office by redesigning check-in and check-out processes.
- Conducted regular staff training sessions to ensure high levels of patient service and care.
Billing Manager/Supervisor
Specialty Billing Services
01.2007 - 01.2010
- Manage multiple projects concurrently, while maintaining a high level of quality and commitment for several providers in the Dallas and Houston area (Spinal, Orthopedics, Cardiology, & OB-GYN providers); including billing, credentialing, and coding
- Training new employees
- Assist with management and workflow of internal and external production
- Work in conjunction with Network Account Managers regarding physician groups
- Demonstrate a high level of quality client service through the execution of accuracy, responsiveness, reliability, and professionalism on every interaction in a fast-paced account management environment
- Facilitate the resolution of credentialing issues and coordinate and complete external and internal determination notification requirements
- Responsible for managing the resolution and status of client requests for all insurance carriers
- Reduced errors and discrepancies in invoicing by closely monitoring billing data and conducting regular audits.
Education
Business School -
Mansfield Business School
Dallas, TX01.1990
High School -
H.G. Spruce High School
Dallas, TX01.1989
Skills
- ECW
- NextGen Practice
- Waystar
- Athena
- Epic
- Traps
- Centricity
- Negotiation's Skills
- Problem Solving Skills
- Microsoft Project
- Medical Billing and Coding
Timeline
Claims Analyst
UnitedHealthcare
01.2022 - Current
Senior Medical Billing Manager
Plutus Medical Billing and Collections
01.2021 - 01.2022
Senior Medical Biller
DIGESTIVE HEALTH ASSOCIATE BILLING GROUP
01.2018 - 01.2021
Billing/ Practice Manager
CLAIMCARE MEDICAL BILLING GROUP
01.2013 - 01.2018
Billing Manager/Supervisor
Specialty Billing Services
01.2007 - 01.2010
Business School -
Mansfield Business School
High School -
H.G. Spruce High School
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