Summary
Overview
Work History
Education
Skills
Timeline
Generic

Camesha Bailey

Virginia Beach,VA

Summary

Considers myself to be motivated, personable, a team-player, and business professional. Have a successful history of providing excellent customer service and have a knack for quickly mastering the necessary skills to complete daily projects and tasks. Considers to be well-versed in customer satisfaction at all levels. Am accustomed to managing sensitive, confidential records and demonstrates history of producing accurate and sound results in a fast-paced work environment. Am flexible and poised under pressure, competent and versatile with the ability to embrace diversity to effectively communicate and thrive in deadline-driven environments.

Overview

13
13
years of professional experience

Work History

Front Desk Night Auditor

Marriott
09.2022 - Current
  • Keeping hotel financial records in order
  • Processing invoices, transactions, room charges, refunds
  • Verifying that all accounts are balanced and supported by documentation
  • Checking guests in and out of hotel
  • Responding to guests' needs, requests, and complaints
  • Managed approximately 50-60 incoming calls, emails and faxes per day from customers
  • Summarizing each night's operations and listing any follow-up tasks for management.
  • Kept accounts in balance and ran daily reports to verify totals.
  • Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.

Performance Quality Analyst II

Anthem Blue Cross Blue Shield
11.2021 - Current
  • Analyzed issues and recommended corrective actions to improve results
  • Participated in technical trainings and workshops to improve skills set and boost overall knowledge
  • Developed quality control procedures for inclusion in technical staff manuals
  • Evaluated audits against quality requirements to maximize efficiency
  • Gathered and inputted data in WGS Mainframe to develop models and assess trends
  • Worked successfully with diverse group of coworkers to accomplish goals and address issues related to products and services
  • Prioritized and organized tasks to efficiently accomplish service goals.
  • Managed emails and faxes per day from providers
  • Mentored new team members on best practices in quality analysis, fostering culture of excellence within organization.
  • Conducted regular performance reviews, providing constructive feedback for employee growth and development.

Medical Management Specialist II

Anthem Blue Cross Blue Shield
06.2019 - 11.2021
  • Maintained and updated tracking databases
  • Knowledge of health plans, including familiarity with prior authorization and pre-certification process
  • Determined contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
  • Served as liaison between users of software and technical staff Assist with complex cases
  • Gathered clinical information regarding case and determines appropriate area to refer or assign case
  • Participated in quality improvement programs to assure that members receive timely, appropriate, and accessible health care
  • Provided ongoing compliance with standardized Health Net, Inc Systems, policies, programs, procedures, and workflows
  • Recommended changes and enhancements to current managed care, prior authorization, concurrent review, case management, disability review guidelines and clinical criteria based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods and treatment protocols
  • Worked to ensure/support appropriate implementation of policies and procedures to maintain compliance with accreditation and regulatory agencies
  • Managed approximately 30-40 emails and faxes per day from providers
  • Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.

Behavioral Health Medical Management Specialist I

Anthem /Amerigroup Corporation
08.2012 - 06.2019
  • Processed incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization
  • Participated in administration of medical management programs to assure that network providers deliver, and Plan members receive appropriate, high-quality, cost-effective care
  • Investigated selected cases reported as deviating from accepted standards and takes appropriate actions.
  • Facilitated cross-functional meetings between departments to improve communication and collaboration within organization.
  • Managed approximately 30 incoming calls, emails and faxes per day from customers

Administrative Assistant

Sentara Healthcare, INC
06.2011 - 04.2013
  • Managed daily operational administrative functions in fast-paced healthcare provider environment
  • Identified trends in service flows and reported back to management with suggested alternatives
  • Performed quality monitoring of incoming patient information to ensure accuracy and completeness
  • Met deadlines with attention to details in planning and scheduling staff, scheduling patient appointments and related daily responsibilities
  • Developed substantial abilities to interpret medical terminology to patients and utilize this skill when contacting insurance providers
  • Demonstrated ability to be flexible in work hours to meet departmental goals and objectives
  • Proven aptitude for working in challenging environment and level one trauma center.
  • Managed approximately 60-70 incoming calls, registered patients and emails per day from patients

Education

Bachelor of Science in Social Psychology - Psychology

Norfolk State University
Norfolk, VA
12.2025

Criminal Justice/Human Services -

TIDEWATER COMMUNITY COLLEGE
Norfolk, VA
01.2015

Skills

  • Microsoft Office Suite

  • Knowledge Management

  • CPSUI

  • Facets

  • Compass/Care Compass

  • ACMP/ACMS

  • Medical Coding

  • Office Administration & Management

  • Time Management

  • Customer Service/Relations

  • Grievance & Appeals Resolution

  • Data Entry & Management

  • Accounts Payable/Receivables

Timeline

Front Desk Night Auditor

Marriott
09.2022 - Current

Performance Quality Analyst II

Anthem Blue Cross Blue Shield
11.2021 - Current

Medical Management Specialist II

Anthem Blue Cross Blue Shield
06.2019 - 11.2021

Behavioral Health Medical Management Specialist I

Anthem /Amerigroup Corporation
08.2012 - 06.2019

Administrative Assistant

Sentara Healthcare, INC
06.2011 - 04.2013

Bachelor of Science in Social Psychology - Psychology

Norfolk State University

Criminal Justice/Human Services -

TIDEWATER COMMUNITY COLLEGE

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Camesha Bailey