Christina Davis
-
Louisville,KY
Summary
Diverse experience with technology, healthcare insurance, and customer service. Results-driven, strong attention to detail and excellent communication skills. Over 15 years working with Microsoft Word, Excel, PowerPoint, and Outlook. Strong ability to gather information quickly and precisely to troubleshoot issues. Seeking to leverage experience towards a more challenging role.
Overview
13
13
years of professional experience
Work History
Quality Audit Coordinator
Humana
05.2024 - Current
- Perform quality checks on auditors in accordance with CMS auditing standards and principles.
- Assist in preparation and presentation of weekly department huddle meetings.
- Chosen to assist in the pilot of auditing grievance cases prior to case closure to provide a better resolution and experience for members.
- SME certified and assist daily in a Sharepoint Q&A site for SMEs to assist auditors with case questions.
- Identify control gaps in processes, procedures and systems through in-depth research and assessment and suggest methods for improvement.
Grievance and Appeals
Humana
09.2022 - 05.2024
- Gather and analyze documentation for verbal and written expedited member and provider appeals.
- Multitasking among several systems and prioritizing work to process pre-authorization appeals within a 72-hour timeline while adhering to Medicare guidelines.
- Prepare insurance documents and review for completeness and accuracy.
- Various outbound communication to members, providers, and external vendors to acquire missing or needed information.
- Prepare resolution communications to both members and providers.
- Maintain strong knowledge of basic medical terminology to better understand services and procedures.
- Consistently achieved above average quality and production scores.
- Recognized as the team's top performer and chosen to serve as the team Appointment of Representative (AOR) specialist. This includes adhering to Medicare and CMS requirements to make various outreach attempts to acquire and validate necessary forms for our team.
Financial Operations Team
Anthem BCBS
12.2013 - 09.2022
- Processed financial refunds from health care providers and policy holders with above average quality rating (100% on average) and utilizing multiple programs simultaneously.
- Manipulated and imported large volumes of financial data for review and processing using Microsoft Excel.
- Led or assisted trainings to assist in various process automations.
- Ran queries with Microsoft Access to pull needed reports.
- Assisted with quality checks after monthly software patch updates.
- Completed minimum of 50 quality reviews of co-workers daily to ensure quality of all transactions.
- Assumed a multitude of tasks from my team lead and other team members to expand my knowledge.
- Recognized by management as highly proficient technician and chosen to assist in training of new associates.
- Consistently received above average ratings on performance reviews.
- Served as team SME and SME certified.
- Served as backup team lead to assist when team lead was out of the office to include assisting team members with questions, pulling needed reports, and communication with various other departments.
Medicare Enrollment Specialist
Humana Inc
08.2011 - 12.2013
- Reviewed pended Medicare Advantage enrollment applications to correct any errors while adhering to CMS guidelines.
- Recognized as quick learner and proficient with operations and chosen to assist in various special projects, including bail-out of group and individual critical errors, PCP (Primary Care Physician), credible coverage, and Special Needs Plans.
- Consistently achieved over 99% on quality reviews, exceeding department requirements.
- Recognized as one of top 5 daily producers on team.
Skills
Public Speaking
Troubleshooting
Adaptability
Analytical skills
Quality control
Customer Service
Written Communication
JavaScript
SQL
Financial Recovery
Process Improvement
Insurance industry experience
Reporting skills
Teamwork and collaboration
Accomplishments
- Twice recognized with Bronze STAR Award.
- Assisted with trainings for process improvement that reduced number of manual letters being created from 100+/daily to less than 10/daily.
- Consistently exceed quality goals at every role, maintaining 99% or above accuracy with all tasks while still exceeding productivity goals.
- Twice recognized with team PIP (Positively Impacting
People) award.
Timeline
Quality Audit Coordinator
Humana
05.2024 - Current
Grievance and Appeals
Humana
09.2022 - 05.2024
Financial Operations Team
Anthem BCBS
12.2013 - 09.2022
Medicare Enrollment Specialist
Humana Inc
08.2011 - 12.2013
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