Alicia Davis
Princeton,TX
Summary
Accomplished Quality Assurance Analyst with 15+ years of experience in the healthcare industry, specializing in medical billing and coding compliance. Proven track record in reviewing medical claims, ensuring adherence to Medicare regulations, and enhancing operational efficiency. Demonstrated leadership in managing teams and implementing quality assurance processes, resulting in improved accuracy and client satisfaction. Certified in Medical Billing, with extensive knowledge of CPT and ICD coding systems.
Overview
1
1
Certification
16
16
years of professional experience
Work History
Appeals & Grievances Specialist
Molina Healthcare
12.2021 - 04.2026
- Enters denials and requests for appeal into information system and prepares documentation for further review.
- Research issues utilizing systems and other available resources.
- Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines.
- Requests and obtain medical records, notes, and/or detailed bills as appropriate to assist with research.
- Determines appropriate language for letters and prepares responses to appeal and grievances.
- Elevates appropriate appeals to the Appeals Specialist.
- Generates and mails denial letters.
- Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner.
- Creates and/or maintains statistics and reporting.
- Works with provider & member services to resolve balance bill issues and other member/provider complaints
Quality Assurance Analyst
HeathSmart
01.2020 - 11.2021
- Review of medical claims according to Medicare Part B billing industry regulations
- Understand and provide explanations of Benefit forms (EOBs)
- Catch Credit balances and request appropriate discounts and refunds according to eligibility
- Handle information related to Insurance codes, Insurance carrier billing requirements, Collections, Provider enrollment, and HIPAA regulations.
- Developed and executed comprehensive test plans to ensure software quality.
- Identified defects and documented issues in tracking systems for resolution.
- Conducted regression testing to verify software updates and enhancements.
- Reported progress, test metrics and results to project stakeholders.
IP Medical Coder
Precision Practice Management
03.2019 - 12.2020
- Audit and assign correct CPT and ICD-10 codes for Orthopedics, GYN, and Internal medicine
- Collaborate with billing department to ensure all bills are satisfied in a timely manner
- Maintain educational requirements
- Research assigned specialties to ensure proper assignment of the codes
- Must be extremely detail oriented and organized, a self-starter capable of tracking deadlines and meeting goals
- Must be able to analyze not only data, but also the logic of data in policies and reports
- Ability to work autonomously and as a team member, with little supervision required
- Reviewed and analyzed medical records for accurate coding in compliance with regulatory standards.
Practice Manager
Infinity Visiting Physicians
01.2016 - 03.2019
- Oversaw the various clinics adhered to any federal and state regulations relevant to the businesses
- Reviewed and enforced compliance with standards or regulations imposed by professional organizations or even a company's internal guidelines
- Identified and recommended new ways to save money by streamlining business processes
- Used statistical methods to analyze data and generate useful business reports
- Oversaw the daily operations in regard to physician signatures, provider credentialing, compliance, physician completion of medical records and physician completion of their daily billing responsibilities
- Ensured compliance with established internal control procedures by examining records, reports, operating practices, and documentation
- Supervised team of 25 office personnel.
- Oversaw daily operations to ensure efficient patient care delivery and resource allocation.
- Implemented process improvements that enhanced service quality and reduced operational costs.
- Developed training programs for staff to elevate performance and improve patient satisfaction outcomes.
- Managed scheduling systems to optimize physician availability and streamline patient appointments.
- Collaborated with healthcare providers to establish best practices in clinical operations and compliance standards.
- Analyzed performance metrics to identify trends, informing strategic decisions for practice growth.
- Led team meetings focused on operational goals, fostering a culture of open communication and collaboration.
- Coordinated multidisciplinary teams to enhance interdisciplinary care approaches and improve patient outcomes.
- 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.
- Developed strong relationships with patients, ensuring a high level of care and satisfaction throughout their experience.
- Developed close working relationships with front office and back office staff.
- Evaluated practice workflows regularly to identify areas for improvement and implement necessary changes efficiently.
- Oversaw the hiring process for new employees, selecting candidates who aligned with the practice''s mission and values.
- Addressed and remedied all patient or team member issues.
- Oversaw accounting, budgeting, and financial reporting.
- Supervised team of 15 office personnel.
Managing Hospital Practice Coordinator
The Schumacher Clinical Partners
04.2013 - 01.2016
- Supported physicians in auditing and billing and compliance with ICD9/CPT coding and chart review to ensure accurate documentation and billing
- Organized the availability of the physicians by phone or pager for scheduled emergencies, patient complaints, or other facility issues
- Enhanced client, PCP, patient, and provider satisfaction as well as quality, case management, emergency department, and other facility relations
- Communicated with PCPs and consulting specialist results pertaining to satisfaction, growth, and discharge summary follow-ups
- Completed tracking forms designated for the Hospitalist Program analyzed to recommend needed improvements to both employer and hospital leadership teams
- Identified on site production, performance, or other issues needed to recommend strategies for improvement
- Reviewed physician payroll monthly to ensure accuracy and opportunities for streamlining costs
- Facilitated engagement of HM Medical Director to result in meeting participation, new provider recruiting and retention
- Managed daily operations and recommended improvements to the practice as it relates to KPI’s, and client provider satisfaction as established by both the employer and the client
- Coordinated patient scheduling and managed appointment logistics to optimize clinic workflow.
Team Lead/ Billing Supervisor
MedAssets
01.2010 - 04.2013
- Reported directly to the Revenue Cycle Manager and responsible for supervising the day-to-day functions of the medical billing team, which consisted of reviewing, coding and collecting all services provided at the clinic, hospital and birthing center
- Implemented policies, procedures and systems for proper coding and quality assurance as directed by Health Care Delivery management
- Reviewed claim information in DDE while monitoring tasks to improve billing practices and increase revenue
- Prepared and submitted reports to management monthly and upon request
- Determined staff level and coordinated with the Revenue Cycle Manager appropriately to meet work volume
- Completed bi-weekly payroll for 10 employees.
Education
Certified Biller - Billing & Coding
Ultimate Medical Academy
Clearwater, FL04-2019
Quarter Master Chemical Specialist
United States Army
01-2016
Skills
- Electronic Health Records (EHR)
- Insurance Claim Processing
- Manage Care (HMO, PPO)
- Government Payers
- Third Party Payers
- Medical Terminology
- Analytical thinking
- Documentation management
Accomplishments
- Resolved product issue through consumer testing.
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Supervised team of 20 staff members.
Certification
- Ultimate Medical Academy | Diploma – Medical Billing and Coding, 2018
- Fully accredited, accelerated program providing instruction in medical billing and ICD-10, CPT and HCPCS coding for diseases, surgeries and medical procedures. Program content includes electronic health record (EHR) systems, accounting methods, and processes for preparing and submitting healthcare claims. Research, professional writing, critical thinking and communications skills are emphasized throughout the program.
Languages
Languages: American Sign Language
Timeline
Appeals & Grievances Specialist
Molina Healthcare
12.2021 - 04.2026
Quality Assurance Analyst
HeathSmart
01.2020 - 11.2021
IP Medical Coder
Precision Practice Management
03.2019 - 12.2020
Practice Manager
Infinity Visiting Physicians
01.2016 - 03.2019
Managing Hospital Practice Coordinator
The Schumacher Clinical Partners
04.2013 - 01.2016
Team Lead/ Billing Supervisor
MedAssets
01.2010 - 04.2013
Certified Biller - Billing & Coding
Ultimate Medical Academy
Quarter Master Chemical Specialist
United States Army